Rebecca Lynn Kirshak
Individual provider Active NPI Specialist · Brookhaven, NY
NPI 1982967881 · NPPES record last updated Jun 17, 2012
Key facts
- NPI
- 1982967881
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 554803 (NY)
- Practice address
- 11 Astor Ave
Brookhaven, NY 11719-9760 - Phone
- (631) 905-9086
- NPI assigned
- Jun 17, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 554803 | NY | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 554803 | NY | Yes |
Addresses
Primary practice location
11 Astor Ave
Brookhaven, NY 11719-9760
Mailing address
11 Astor Ave
Brookhaven, NY 11719-9760
Phone (631) 905-9086
Other providers in Brookhaven, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.