Healthcare Provider Details

I. General information

NPI: 1841345022
Provider Name (Legal Business Name): BROOKHAVEN NEPHROLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PATCHOGUE YAPHANK RD SUITE F
EAST PATCHOGUE NY
11772-4886
US

IV. Provider business mailing address

260 PATCHOGUE YAPHANK RD STE F
EAST PATCHOGUE NY
11772-4886
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-8755
  • Fax: 631-654-8709
Mailing address:
  • Phone: 631-654-8755
  • Fax: 631-654-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MOHAMMED RAHMAN
Title or Position: MD
Credential:
Phone: 631-654-8755