Provider Demographics
NPI:1427495068
Name:BRIAN BEZACK DO PLLC
Entity type:Organization
Organization Name:BRIAN BEZACK DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZACK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-499-1298
Mailing Address - Street 1:6080 JERICHO TPKE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2850
Mailing Address - Country:US
Mailing Address - Phone:631-499-1298
Mailing Address - Fax:631-486-6712
Practice Address - Street 1:6080 JERICHO TPKE
Practice Address - Street 2:SUITE 318
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2850
Practice Address - Country:US
Practice Address - Phone:631-499-1298
Practice Address - Fax:631-486-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2156742080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty