Provider Demographics
NPI:1083047971
Name:BROOKHAVEN NEUROLOGY PLLC
Entity Type:Organization
Organization Name:BROOKHAVEN NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL-PULIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-654-2386
Mailing Address - Street 1:74 SOUTHAVEN AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3746
Mailing Address - Country:US
Mailing Address - Phone:631-654-2386
Mailing Address - Fax:631-447-3852
Practice Address - Street 1:74 SOUTHAVEN AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3746
Practice Address - Country:US
Practice Address - Phone:631-654-2386
Practice Address - Fax:631-447-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2662542084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty