Provider Demographics
NPI:1134259716
Name:NYFIELD, BRUCE (PHD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:NYFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 STURROCK WAY
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11233
Mailing Address - Country:US
Mailing Address - Phone:631-751-1166
Mailing Address - Fax:631-251-0889
Practice Address - Street 1:627 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11258
Practice Address - Country:US
Practice Address - Phone:631-751-1166
Practice Address - Fax:631-751-0889
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
NY013459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01852116Medicaid
NYV79802Medicare ID - Type Unspecified