Provider Demographics
NPI:1841386299
Name:BRUSTEIN, HARRIS CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:CHARLES
Last Name:BRUSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:77 QUAKER RIDGE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2808
Mailing Address - Country:US
Mailing Address - Phone:914-235-0022
Mailing Address - Fax:914-636-2722
Practice Address - Street 1:77 QUAKER RIDGE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2808
Practice Address - Country:US
Practice Address - Phone:914-235-0022
Practice Address - Fax:914-636-2722
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109441207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWS907OtherOXFORD
NY41394OtherGHI
NYWS907OtherOXFORD
B16511Medicare UPIN