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General NPI Number Information
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NPI Number | 1427495068
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Entity Type | Organization
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Legal Business Name | BRIAN BEZACK DO PLLC
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 05/22/2013
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Provider Practice Location Address
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Address Line | 6080 JERICHO TPKE SUITE 318
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City | COMMACK
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State | NY
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Zip | 11725-2850
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Country | US
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Telephone | 631-499-1298
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Fax | 631-486-6712
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Provider Business Mailing Address
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Address Line | 6080 JERICHO TPKE SUITE 318
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City | COMMACK
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State | NY
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Zip | 11725-2850
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Country | US
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Telephone | 631-499-1298
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Fax | 631-486-6712
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN BEZACK
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Credential | D.O.
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Telephone | 631-499-1298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 215674
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License Number State | NY
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