Healthcare Provider Details

I. General information

NPI: 1326179383
Provider Name (Legal Business Name): BRIAN F MIRMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 HYLAN BLVD SUITE D
STATEN ISLAND NY
10306
US

IV. Provider business mailing address

2627 HYLAN BLVD SUITE D
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-6000
  • Fax: 718-667-6350
Mailing address:
  • Phone: 718-667-6000
  • Fax: 718-667-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number32106
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: