Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 251674 | NY |
Y | 2080P0214X | Pediatric Pulmonologist | 251674 | NY |
NPI | 1407021850 |
---|---|
Provider Name | Dr. Brian J Bezack |
First Address | Commack, NY 11725-3405 |
Second Address | Commack, NY 11725-3405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 08/08/2016 |