# JUSTIN MIRZA D.O. PC

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

## Provider details

- **NPI number:** 1508252321
- **Authorized official:** DR. JUSTIN BRUNO MIRZA D.O. (PRESIDENT)
- **Authorized official phone:** (631) 361-5302

## Contact information

- **Practice address:** 290 E MAIN ST, SUITE 200, SMITHTOWN, NY 11787-2916
- **Practice address phone:** (631) 361-5302
- **Practice address fax:** (631) 361-8607
- **Mailing address:** 290 E MAIN ST, SUITE 200, SMITHTOWN, NY 11787-2916
- **Mailing address phone:** (631) 361-5302
- **Mailing address fax:** (631) 361-8607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207XS0106X | Orthopaedic Hand Surgery Physician | 258198 | NY | Yes |

## Other

- **Enumeration date:** 04/08/2015
- **Last updated:** 04/08/2015