Individual
MR. BRETT KORNBLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
146 VIRGINIA AVE, OCEANSIDE, NY 11572-5433
(516) 314-1234
Mailing address
146 VIRGINIA AVE, OCEANSIDE, NY 11572-5433
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
946490151
NY
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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