=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720014574
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN THOMAS MCGUINNESS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 01/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 PATCHOGUE YAPHANK RD SUITE 1
-----------------------------------------------------
City | EAST PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-475-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 PATCHOGUE YAPHANK RD SUITE 1
-----------------------------------------------------
City | EAST PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-475-3355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 165780
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------