Provider Demographics
NPI:1821177981
Name:BROOKHAVEN CARDIAC LLC
Entity Type:Organization
Organization Name:BROOKHAVEN CARDIAC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-654-2386
Mailing Address - Street 1:475 E MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-654-2386
Mailing Address - Fax:631-447-3852
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-654-2386
Practice Address - Fax:631-447-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100030955Medicare PIN