Provider Demographics
NPI:1407021850
Name:BEZACK, BRIAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:BEZACK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:66 COMMACK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3405
Mailing Address - Country:US
Mailing Address - Phone:631-499-1298
Mailing Address - Fax:631-499-1700
Practice Address - Street 1:66 COMMACK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3405
Practice Address - Country:US
Practice Address - Phone:631-499-1298
Practice Address - Fax:631-499-1700
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2016-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2516742080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics