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General NPI Number Information
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NPI Number | 1366822793
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Entity Type | Organization
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Legal Business Name | TMH MEDICAL HOME
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 6144 ROUTE 25A
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City | WADING RIVER
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State | NY
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Zip | 11792-2018
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Country | US
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Telephone | 631-929-5900
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Fax | 631-886-2750
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Provider Business Mailing Address
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Address Line | 1272 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2583
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Country | US
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Telephone | 631-284-3793
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Fax | 631-729-3111
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BELLAMY BROOK
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Credential | DO
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Telephone | 631-284-3793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 215053
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License Number State | NY
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