Provider Demographics
NPI:1912198698
Name:BRUSSICH, STEVEN JOHN (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOHN
Last Name:BRUSSICH
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1602
Mailing Address - Country:US
Mailing Address - Phone:718-543-3336
Mailing Address - Fax:718-543-6463
Practice Address - Street 1:5901 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1602
Practice Address - Country:US
Practice Address - Phone:718-543-3336
Practice Address - Fax:718-543-6463
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006368-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician