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General NPI Number Information
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NPI Number | 1578772166
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN PHYSICAL MEDICINE AND REHABILITATION, P.C.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 240 PATCHOGUE YAPHANK RD SUITE 101
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4868
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Country | US
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Telephone | 631-289-8928
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Fax | 631-289-8980
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Provider Business Mailing Address
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Address Line | 240 PATCHOGUE YAPHANK RD SUITE 101
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4868
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Country | US
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Telephone | 631-289-8928
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Fax | 631-289-8980
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER CHIU
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Credential | MD
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Telephone | 631-289-8928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 204994
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License Number State | NY
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