Provider Demographics
NPI:1366822793
Name:TMH MEDICAL HOME
Entity Type:Organization
Organization Name:TMH MEDICAL HOME
Other - Org Name:HEALTH NOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BELLAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-284-3793
Mailing Address - Street 1:1272 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2583
Mailing Address - Country:US
Mailing Address - Phone:631-284-3793
Mailing Address - Fax:631-729-3111
Practice Address - Street 1:6144 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2018
Practice Address - Country:US
Practice Address - Phone:631-929-5900
Practice Address - Fax:631-886-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215053332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4P8822Medicare PIN
NYH34115Medicare UPIN