Bruce a Fastenberg MD PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

210692 Issued in NY

Legal business name

BRUCE A FASTENBERG MD PLLC

Practice address

260 West Broadway
Suite 6F
Long Beach, NY 11561

Phone

(917) 838-5680

NPI assigned

Oct 10, 2006

Last updated

Dec 26, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bruce A Fastenberg, MDNPI 1396840708

Title

Physician

Phone

(917) 838-5680

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bruce A Fastenberg, MD

  • Ophthalmology Physician
  • Long Beach, NY
  • NPI 1396840708
  NPD (past) Authorized official

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419552000000",
    "number": "1407944275",
    "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": {
        "organization_name": "BRUCE A FASTENBERG MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2014-12-26",
        "status": "A",
        "authorized_official_last_name": "FASTENBERG",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "917-838-5680",
        "authorized_official_credential": "MD"
    },
    "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": []
}

• Lauren Elisabeth Broderick, PMHNP
• Mark A Brodsky, RPH
• Margreth J. Brontoli, MD
• Diane Brous, M.A. SPECIAL ED
• Keri Brucato, M.ED.
• Rosalin Brueck, LMHC
• Samantha Elizabeth Brumfield, LICENSED PRACTICAL N
• Keith Spencer Bryan, LCSW
• Brucha Buff, PA-C
• Jennifer Murray Buonocore, MS, OTR/L

• 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.