Provider Demographics
NPI:1326508557
Name:LEARNED, BROOKE NOELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:NOELLE
Last Name:LEARNED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 SMITH HAVEN MALL STE 203
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1219
Mailing Address - Country:US
Mailing Address - Phone:631-444-0580
Mailing Address - Fax:631-444-0562
Practice Address - Street 1:4 SMITH HAVEN MALL STE 203
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1219
Practice Address - Country:US
Practice Address - Phone:631-444-0580
Practice Address - Fax:631-444-0562
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY314434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program