Organization
BRUCE A FASTENBERG MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE A FASTENBERG MD (PHYSICIAN)
(917) 838-5680
Entity
Organization
Contact information
Practice address
260 WEST BROADWAY, SUITE 6F, LONG BEACH, NY 11561
(917) 838-5680
Mailing address
260 WEST BROADWAY, SUITE 6F, LONG BEACH, NY 11561
(917) 838-5680
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
210692
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02191073
—
NY
Enumeration date
10/10/2006
Last updated
12/26/2014
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