Provider Demographics
NPI:1639155419
Name:BEIRNE, BRIAN F (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:BEIRNE
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:PO BOX 826223
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6223
Mailing Address - Country:US
Mailing Address - Phone:866-898-7142
Mailing Address - Fax:770-237-1723
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200030-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02444140Medicaid
NY854V11OtherBLUECROSS BLUESHIELD
H57271Medicare UPIN
NY854V11OtherBLUECROSS BLUESHIELD
NY710V51Medicare PIN