MEDICARE: BRIGHTON MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	477215	OTHER	NY	THE JOINT COMMISSION

General Provider Information

NPI Number	:	1548494669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTON MEDICAL PC

Provider Business Mailing Address
First Line	:	8033 SHORE RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2839
Country	:	US
Telephone Number	:	718-833-8777
Fax Number	:	718-646-8400

Provider Business Practice Location Address
First Line	:	1180 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5801
Country	:	US
Telephone Number	:	718-833-8777
Fax Number	:	718-646-8400

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	IRENE KAKOSSIAN
Credential	:	M.D.
Telephone Number	:	718-833-8777

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	01/10/2017

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Directions to “BRIGHTON MEDICAL PC ” Practice Location

Language	Start Address	Practice Location

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