PORT INTERVENTIONAL RADIOLOGY PC; NPI #1164434924

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

NPI # 1164434924

LBN Legal business name PORT INTERVENTIONAL RADIOLOGY PC

Authorized official EDWARD GLENN - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 08/12/2006

Last updated 08/22/2020 - About 6 years ago

Identifiers

Medicaid

01643636

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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