Individual
JUSTIN BRUNO MIRZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
51-15 BEACH CHANNEL DRIVE, PENINSULA HOSPITAL CENTER, FAR ROCKAWAY, NY 11691
(718) 734-3020
Mailing address
51-15 BEACH CHANNEL DRIVE, PEINISULA HOSPITAL CENTER, FAR ROCKAWAY, NY 11691
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
258198
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258198
—
NY
Enumeration date
02/24/2011
Last updated
02/24/2011
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