Provider Demographics
NPI:1508871484
Name:HAMPTON ORTHOPEDIC AND SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:HAMPTON ORTHOPEDIC AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-287-9477
Mailing Address - Street 1:325 MEETING HOUSE LANE BLDG 2
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTH HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968
Mailing Address - Country:US
Mailing Address - Phone:631-287-9477
Mailing Address - Fax:631-287-9751
Practice Address - Street 1:504B MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934
Practice Address - Country:US
Practice Address - Phone:631-287-9477
Practice Address - Fax:631-287-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2113301111NX0800X
NY2113302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2113302OtherCENTER PROVIDER
NY2113301OtherSOUTH HAMPTON
NY2113301OtherSOUTH HAMPTON
NY2113302OtherCENTER PROVIDER
G99272Medicare UPIN