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General NPI Number Information
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NPI Number | 1962798983
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Entity Type | Individual
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Provider Name | BRIAN W AULT DO, MS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 101 HOSPITAL RD EMERGENCY DEPARTMENT ADMINISTRATIVE OFFICE
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4870
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Country | US
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Telephone | 631-239-1824
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Fax |
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4870
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Country | US
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Telephone | 631-654-7763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 276229
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DO2416
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License Number State | NV
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