Provider Demographics
NPI:1891925095
Name:BRIGHTON MEDICAL DIAGNOSTIC
Entity Type:Organization
Organization Name:BRIGHTON MEDICAL DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-476-8977
Mailing Address - Street 1:1150 BRIGHTON BEACH AVE
Mailing Address - Street 2:#1CC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5901
Mailing Address - Country:US
Mailing Address - Phone:917-476-8977
Mailing Address - Fax:
Practice Address - Street 1:1150 BRIGHTON BEACH AVE
Practice Address - Street 2:#1CC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5901
Practice Address - Country:US
Practice Address - Phone:917-476-8977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty