Provider Demographics
NPI:1912631417
Name:SRB MEDICAL PLLC
Entity Type:Organization
Organization Name:SRB MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSHTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-804-7028
Mailing Address - Street 1:1875 KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1875 KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4303
Practice Address - Country:US
Practice Address - Phone:347-804-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty