Bruce A Fastenberg, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

210692 Issued in NY

Practice address

260 West Broadway
Suite 6F
Long Beach, NY 11561

Phone

(917) 838-5680

NPI assigned

Sep 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bruce a Fastenberg MD PLLC

  • Ophthalmology Physician
  • Long Beach, NY
  • NPI 1407944275
  NPD (past) Authorized official
• William Fastenberg MD PC

  • Ophthalmology Physician
  • Long Beach, NY
  • NPI 1821209263
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419552000000",
    "number": "1396840708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 WEST BROADWAY",
            "address_2": "SUITE 6F",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "11561",
            "telephone_number": "917-838-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 WEST BROADWAY",
            "address_2": "SUITE 6F",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "11561",
            "telephone_number": "917-838-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASTENBERG",
        "first_name": "BRUCE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "210692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02191073",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evergreen Ear, Nose & Throat Surgery P.C.
• Tara C Ey-Defazio, TSHH/DHH
• Nicole S Fader, LMT
• Ronald Harlan Falcon, M.D.
• Family Mental Health
• Meghan Featherston, OTR/L
• Teuta Feinberg, PSY.D.
• Iris Feingold, M.S., CCC-SLP
• Richard Felber Jr.
• Bridget Felder

• Ophthalmology Physician in Long Beach, NY
• Providers in Long Beach, NY by specialty
• Ophthalmology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.