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General NPI Number Information
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NPI Number | 1871661132
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Entity Type | Individual
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Provider Name | MR. BRUCE DAVID MIRKIN
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Gender | Male
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 28 S PARK AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-5280
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Country | US
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Telephone | 516-766-2800
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Fax | 516-766-0222
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Provider Business Mailing Address
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Address Line | 28 S PARK AVE
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-5280
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Country | US
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Telephone | 516-766-2800
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Fax | 516-766-0222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 004817-1
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License Number State | NY
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