Healthcare Provider Details

I. General information

NPI: 1639260607
Provider Name (Legal Business Name): BROOKHAVEN HEART PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E MAIN ST STE 120
PATCHOGUE NY
11772-3114
US

IV. Provider business mailing address

325 E MAIN ST STE 120
PATCHOGUE NY
11772-3114
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-3278
  • Fax: 631-654-1474
Mailing address:
  • Phone: 631-654-3278
  • Fax: 631-654-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number222332
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number222332
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number222332
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number222332
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SATHEESH JOSEPH
Title or Position: PRESIDENT
Credential: MD
Phone: 631-654-3278