Provider Demographics
NPI:1407938764
Name:FALK, BRYAN M (DO)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:FALK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552
Mailing Address - Country:US
Mailing Address - Phone:718-639-1176
Mailing Address - Fax:718-565-6656
Practice Address - Street 1:6352 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-639-1176
Practice Address - Fax:718-565-6656
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129043207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00790556Medicaid
P674411OtherOXFORD
03951AMedicare ID - Type Unspecified
B13678Medicare UPIN