Provider Demographics
NPI:1841406980
Name:BROOKHAVEN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BROOKHAVEN PHYSICAL THERAPY
Other - Org Name:MILLER PLACE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-345-2005
Mailing Address - Street 1:41 ECHO AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2108
Mailing Address - Country:US
Mailing Address - Phone:631-331-2348
Mailing Address - Fax:631-928-7068
Practice Address - Street 1:200 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2520
Practice Address - Country:US
Practice Address - Phone:631-345-2005
Practice Address - Fax:631-345-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011801-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0210001OtherHEALTHNET ORTHONET
NY12067099OtherMULTIPLAN
NYDM0Q03821OtherBCBS
NY6602110OtherGHI
NY813476OtherMPN
NYA493957OtherOXFORD
NY20473POtherHIP
NYAZ00671OtherMDNY
NY107487200OtherACS
NY2176073OtherFIRST HEALTH
NY124896OtherVYTRA
NY1295268OtherUNITED HEALTHCARE
NY1C0216OtherHEALTHNET
NY124896OtherVYTRA