Provider Demographics
NPI:1578772166
Name:BROOKHAVEN PHYSICAL MEDICINE AND REHABILITATION, P.C.
Entity Type:Organization
Organization Name:BROOKHAVEN PHYSICAL MEDICINE AND REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-289-8928
Mailing Address - Street 1:240 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4868
Mailing Address - Country:US
Mailing Address - Phone:631-289-8928
Mailing Address - Fax:631-289-8980
Practice Address - Street 1:240 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4868
Practice Address - Country:US
Practice Address - Phone:631-289-8928
Practice Address - Fax:631-289-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204994208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG96796Medicare UPIN