Provider Demographics
NPI:1609013580
Name:DR. BELLAMY BROOK DO PC
Entity Type:Organization
Organization Name:DR. BELLAMY BROOK DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BELLAMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO PC
Authorized Official - Phone:631-998-3434
Mailing Address - Street 1:300 OLD COUNTRY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2146
Mailing Address - Country:US
Mailing Address - Phone:631-405-5544
Mailing Address - Fax:
Practice Address - Street 1:300 OLD COUNTRY RD STE 2
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2146
Practice Address - Country:US
Practice Address - Phone:631-405-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215053-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY215053-1OtherSTATE PROFESSIONAL LICENSE
NY11541228OtherCAQH ID
NY11541228OtherCAQH ID
NYH34115Medicare UPIN
NY4P8822Medicare PIN