Provider Demographics
NPI:1841345022
Name:BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-654-8755
Mailing Address - Street 1:260 PATCHOGUE YAPHANK RD STE F
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4886
Mailing Address - Country:US
Mailing Address - Phone:631-654-8755
Mailing Address - Fax:631-654-8709
Practice Address - Street 1:260 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE F
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4886
Practice Address - Country:US
Practice Address - Phone:631-654-8755
Practice Address - Fax:631-654-8709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW38231Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER