Healthcare Provider Details

I. General information

NPI: 1982631545
Provider Name (Legal Business Name): BRUCE S STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26112 E WILLISTON AVE
FLORAL PARK NY
11001-1145
US

IV. Provider business mailing address

26112 E WILLISTON AVE
FLORAL PARK NY
11001-1145
US

V. Phone/Fax

Practice location:
  • Phone: 718-347-8888
  • Fax: 718-347-8889
Mailing address:
  • Phone: 718-347-8888
  • Fax: 718-347-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number191991
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: