| Organization Name: | BROOKHAVEN PHYSICIAN SERVICES, P. C. |
| NPI Number: | 1083807572 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TROY DICKINSON (AUTHORIZED OFFICIAL) |
| Mailing Address: | 100 Hospital Rd Suite 203 East Patchogue |
| State: | NY US |
| Postal Code: | 117728809 |
| Phone Number: | 6314756900 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2007 |
| NPI Last Update Date: | 01/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |