| Brian Ghezelaiagh, Md, Pc | |
|
2500 Nesconset Hwy Bldg 17c Stony Brook NY 11790-2563 | |
| (631) 210-6305 | |
| (631) 292-7376 |
| Full Name | Brian Ghezelaiagh, Md, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2500 Nesconset Hwy Bldg 17c, Stony Brook, New York |
| Authorized Official Name and Position | Brian Ghezelaiagh (OWNER) |
| Authorized Official Contact | 6312106305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Ghezelaiagh, Md, Pc 2500 Nesconset Hwy Bldg 17c Stony Brook NY 11790-2563 Ph: (631) 210-6305 | Brian Ghezelaiagh, Md, Pc 2500 Nesconset Hwy Bldg 17c Stony Brook NY 11790-2563 Ph: (631) 210-6305 |
| NPI Number | 1659140747 |
|---|---|
| Provider Enumeration Date | 12/29/2023 |
| Last Update Date | 12/29/2023 |
| Certification Date | 12/29/2023 |
| Medicare PECOS PAC ID | 6002258746 |
|---|---|
| Medicare Enrollment ID | O20240524003338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659140747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Brian Ghezelaiagh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033616206 PECOS PAC ID: 1052793841 Enrollment ID: I20240524003367 |
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