PORT INTERVENTIONAL RADIOLOGY PC PORT JEFFERSON, NY

Contact Information

PORT INTERVENTIONAL RADIOLOGY PC

75 NORTH COUNTRY ROAD
PORT JEFFERSON, NY 11777

Phone: 631-476-2757
Fax: 631-473-0132
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Diagnostic Radiology	2085R0202X	30	Physician/Diagnostic Radiology

Indicates primary specialty

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NPI Profile & details for PORT INTERVENTIONAL RADIOLOGY PC · (Female)

NPI Number	`1164434924`
Status	Active
Credentials
Entity	Individual
Enumeration date	08/12/2006
Last updated	08/22/2020 - About 6 years ago
Sole proprietor ¹	Not specified
Identifiers	NY Medicaid 01643636
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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