Basic Information
| Provider Information | |||||||||
| NPI: | 1710965363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROCK | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 MOTOR PKWY STE 309 | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117885124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315147600 | ||||||||
| FaxNumber: | 6318131472 | ||||||||
| Practice Location | |||||||||
| Address1: | 168 S HOWELL ST | ||||||||
| Address2: | |||||||||
| City: | HILLSDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492422040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174374451 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34009716 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 04282 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 5101011514 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.