# INTEGRATIVE MEDICINE OF BROOKHAVEN P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336647213
- **Authorized official:** DR. DIMOS G KANAKOUDAS MD (OWNER/MEDICAL DIRECTOR)
- **Authorized official phone:** (646) 824-1380

## Contact information

- **Practice address:** 59 NESCONSET HWY FL 2, PORT JEFFERSON STATION, NY 11776-2628
- **Practice address phone:** (646) 824-1380
- **Mailing address:** 7 LOST MEADOW LN, PORT JEFFERSON, NY 11777-1127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 257261 | NY | Yes |

## Other

- **Enumeration date:** 01/25/2018
- **Last updated:** 03/14/2021