Provider Demographics
NPI:1548494669
Name:BRIGHTON MEDICAL PC
Entity type:Organization
Organization Name:BRIGHTON MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-833-8777
Mailing Address - Street 1:8033 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2839
Mailing Address - Country:US
Mailing Address - Phone:718-833-8777
Mailing Address - Fax:718-646-8400
Practice Address - Street 1:1180 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5801
Practice Address - Country:US
Practice Address - Phone:718-833-8777
Practice Address - Fax:718-646-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY477215OtherTHE JOINT COMMISSION