Provider Demographics
NPI:1699254326
Name:BRUSTEIN, MIRIAH
Entity type:Individual
Prefix:
First Name:MIRIAH
Middle Name:
Last Name:BRUSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4316
Mailing Address - Country:US
Mailing Address - Phone:845-633-8397
Mailing Address - Fax:
Practice Address - Street 1:1111 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:NY
Practice Address - Zip Code:12525-5518
Practice Address - Country:US
Practice Address - Phone:845-633-8806
Practice Address - Fax:845-255-5271
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator