Provider Demographics
NPI:1093368557
Name:FACTOR, BRUCE ASHER
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ASHER
Last Name:FACTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 GASTON ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3026
Mailing Address - Country:US
Mailing Address - Phone:516-221-9358
Mailing Address - Fax:516-889-9245
Practice Address - Street 1:62 LIDO BLVD
Practice Address - Street 2:
Practice Address - City:POINT LOOKOUT
Practice Address - State:NY
Practice Address - Zip Code:11569-3021
Practice Address - Country:US
Practice Address - Phone:516-889-3444
Practice Address - Fax:516-889-9245
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist