Integrative Medicine of Brookhaven P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

257261 Issued in NY

Legal business name

INTEGRATIVE MEDICINE OF BROOKHAVEN P.C.

Practice address

59 Nesconset Hwy FL 2
Port Jefferson Station, NY 11776-2628

Phone

(646) 824-1380

NPI assigned

Jan 25, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dimos G Kanakoudas, MD

Title

Owner/Medical Director

Phone

(646) 824-1380

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615680000000",
    "number": "1336647213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 LOST MEADOW LN",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 NESCONSET HWY FL 2",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762628",
            "telephone_number": "646-824-1380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2848 Middle Country Rd",
            "address_purpose": "LOCATION",
            "city": "Lake Grove",
            "state": "NY",
            "postal_code": "117552104",
            "country_code": "US",
            "telephone_number": "631-780-5550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "59 Merrick Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Amityville",
            "state": "NY",
            "postal_code": "117013453",
            "country_code": "US",
            "telephone_number": "646-824-1380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATIVE MEDICINE OF BROOKHAVEN P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-25",
        "last_updated": "2021-03-14",
        "certification_date": "2021-03-14",
        "status": "A",
        "authorized_official_last_name": "KANAKOUDAS",
        "authorized_official_first_name": "DIMOS",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "646-824-1380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "257261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Independent Staffing
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• Family Medicine Physician in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.