Organization
DR. BELLAMY BROOK DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BELLAMY BROOK D.O. PC (PHYSICIAN)
(631) 998-3434
Entity
Organization
Contact information
Practice address
300 OLD COUNTRY RD STE 2, RIVERHEAD, NY 11901-2146
(631) 405-5544
Mailing address
300 OLD COUNTRY RD STE 2, RIVERHEAD, NY 11901-2146
(631) 405-5544
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
215053-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11541228
CAQH ID
NY
01
—
215053-1
STATE PROFESSIONAL LICENSE
NY
Enumeration date
01/14/2009
Last updated
03/07/2023
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