BROOKHAVEN NEUROLOGY PLLC (NPI# 1083047971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083047971 |
| Entity Type | Organization |
| Organization Name | BROOKHAVEN NEUROLOGY PLLC |
| Practice Address |
74 Southaven Ave Suite G Medford NY 11763-3746 |
| Practice Telephone | 6316542386 |
| Practice Fax Number | 6314473852 |
| Mailing Telephone | 6316542386 |
| Mailing Fax Number | 6314473852 |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |
| Authorized Official Name | DR. PINA PATEL-PULIPATI (DIRECTOR) |
| Authorized Official Telephone | 6316542386 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
266254 | NY | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
266254 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
74 SOUTHAVEN AVE SUITE G |
| City | MEDFORD |
| State | NY |
| Zip Code | 11763-3746 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922010719 | Inderjit Katyal | Internal Medicine | 74 Southaven Ave, Medford, NY 11763-3746 | 2006-08-12 |
| 1639391915 | Frank C Perry | Dentist | 74 Southaven Ave, Ste A, Medford, NY 11763 | 2007-05-03 |
| 1669537932 | Natale F Spata | Chiropractor | 74 Southaven Ave, Suite B, Medford, NY 11763-3746 | 2006-12-26 |
| 1336201227 | Rana Zoeb | Internal Medicine | 74 Southaven Ave, Suite C, Medford, NY 11763 | 2006-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316572027 | Rebecca Molino | Specialist | 9, 3251 Ny-112 #2, Medford, NY 11763 | 2020-03-03 |
| 1295203677 | Hajar Taman | Pharmacist | 2975 Horseblock Road, Medford, NY 11763 | 2018-11-05 |
| 1265917041 | Bay Taxi Inc | Taxi | 36/94 Horseblock Rd, Medford, NY 11763 | 2018-09-27 |
| 1184108383 | Bay Taxi Inc | Taxi | 36/94 Horsblock Road, Medford, NY 11763 | 2018-09-24 |
| 1215419650 | Megan Bell | Speech-Language Pathologist | 135 Buffalo Avenue, Medford, NY 11763 | 2018-09-01 |
| 1922592906 | Elizabeth L Oakley | Specialist | 1 Sprat St, Medford, NY 11763 | 2018-06-21 |
| 1609383389 | Federation of Organizations for The New York State Mentally Disabled | Clinic/Center | 3390 Route 112 Ste B, Medford, NY 11763 | 2018-01-04 |
| 1497109607 | Tabitha Aitken | Massage Therapist | 28 Masem Ct, Medford, NY 11763 | 2016-04-14 |
| 1518326685 | Betty Velez | Specialist | 21 Red Pine Rd, Medford, NY 11763 | 2016-02-18 |
| 1134527054 | Angelo L D'esposito | Social Worker | 77 Robinson Ave, Medford, NY 11763 | 2014-12-09 |
| Find all providers in zip 11763 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659519767 | Cynthia Shearn Tainsh | Psychiatry & Neurology | 97 Westwood Rd, Medford, MA 02155-1637 | 2009-01-27 |
| 1528217460 | Christopher Dardis | Psychiatry & Neurology | 2900 State St Ste 101, Medford, OR 97504-8458 | 2008-09-16 |
| 1225249675 | Bruce Ehrenberg | Psychiatry & Neurology | 4 Colby St, Medford, MA 02155-6013 | 2007-05-25 |
| 1366658627 | Nishant Singh Ranawat | Psychiatry & Neurology | Asante Rogue Regional Medical Center, 2825 E Barnett Road, Medford, OR 97504 | 2007-05-15 |
| 1922143296 | Eugenia Blank | Psychiatry & Neurology | 170 Governors Ave Ste 258, Medford, MA 02155-1643 | 2007-02-21 |
| 1912963661 | Larry Jou Maukonen | Psychiatry & Neurology | 897 Royal Ave, Suite B, Medford, OR 97504 | 2006-04-21 |
| 1265416317 | South Jersey Neurocare Pa | Psychiatry & Neurology | 520 Stokes Rd, Suite A-4, Medford, NJ 08055-2904 | 2005-12-02 |
| 1063412427 | Oscar Adolfo Sanchez | Psychiatry & Neurology | 520 Medical Center Drive, Medford, OR 97504 | 2005-07-28 |
| 1720424591 | Minji Kim | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504-6169 | 2013-05-20 |
| 1578821013 | Sabre Amira Patton-fee | Psychiatry & Neurology | 920 Royal Ave, Medford, OR 97504 | 2012-05-02 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.