Individual
DR. MINA M BISHARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 PARK AVE, NEW YORK, NY 10016-2553
(212) 370-1001
Mailing address
400 N BROADWAY, JERICHO, NY 11753-2113
(516) 992-6340
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
060755
NY
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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