Provider Demographics
NPI:1487826921
Name:GEORGE, BRENDA POYKAYIL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:POYKAYIL
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 PULASKI RD
Mailing Address - Street 2:DOLAN FAMILY HEALTH CENTER
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1602
Mailing Address - Country:US
Mailing Address - Phone:631-425-5250
Mailing Address - Fax:
Practice Address - Street 1:284 PULASKI RD
Practice Address - Street 2:DOLAN FAMILY HEALTH CENTER
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1602
Practice Address - Country:US
Practice Address - Phone:631-425-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03254840Medicaid
A400033510Medicare PIN