# BRUCE A FASTENBERG MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407944275
- **Authorized official:** BRUCE A FASTENBERG MD (PHYSICIAN)
- **Authorized official phone:** (917) 838-5680

## Contact information

- **Practice address:** 260 WEST BROADWAY, SUITE 6F, LONG BEACH, NY 11561
- **Practice address phone:** (917) 838-5680
- **Mailing address:** 260 WEST BROADWAY, SUITE 6F, LONG BEACH, NY 11561
- **Mailing address phone:** (917) 838-5680

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 210692 | NY | Yes |

## Other

- **Enumeration date:** 10/10/2006
- **Last updated:** 12/26/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 02191073 | — | NY |