Provider Demographics
NPI:1700916160
Name:SILBERBERG, BRUCE TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TODD
Last Name:SILBERBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WEST PARK AVE
Mailing Address - Street 2:SUITE 210C
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:516-889-2727
Mailing Address - Fax:516-889-2727
Practice Address - Street 1:100 WEST PARK AVE
Practice Address - Street 2:SUITE 210C
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-889-2727
Practice Address - Fax:516-889-2727
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24609111N00000X
NYX0096731111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
X4H31Medicare ID - Type Unspecified
U85827Medicare UPIN