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Contact Information

BRUCE A FASTENBERG, MD
260 WEST BROADWAY
SUITE 6F
LONG BEACH, NY11561
 Phone: 917-838-5680
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Ophthalmology

207W00000X 18 Physician/Ophthalmology
Indicates primary specialty

NPI Profile & details for BRUCE A FASTENBERG · (Male)

NPI Number 1396840708
Status Active
Credentials MD
Entity Individual
Enumeration date 09/13/2006
Last updated 12/26/2014 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 210692
  • NY Medicaid 02191073
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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