Fastenberg, Bruce A
Fastenberg, Bruce A is an individual health care provider with primary practice located at 260 West Broadway Suite 6F, Long Beach NY 11561. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Fastenberg, Bruce A can be contacted via phone (917) 838-5680.Contact Information
Primary practice address
260 West Broadway Suite 6F
Long Beach NY 11561
Phone: (917) 838-5680
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 210692 | New York |
Profile Details
| NPI number | 1396840708 |
|---|---|
| LBN Legal business name | Fastenberg, Bruce A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 13th, 2006 |
| Last updated | Dec 26th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396840708 | NPPES |
| New York | MEDICAID | 02191073 |
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