National Provider Identifier Database

PORT RADIATION THERAPY PC
Diagnostic Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.


Contact Information

PORT RADIATION THERAPY PC
75 N COUNTRY RD
PORT JEFFERSON, NY11777
Phone: 631-476-2757
Fax:
Website:
Specialty Taxonomy Code
* Diagnostic Radiology 2085R0202X

* Indicates primary specialty

NPI Profile & details for PORT RADIATION THERAPY PC

NPI Number 1356412035
Legal business name
LBN
PORT RADIATION THERAPY PC
Authorized official EDWARD GLENN - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 11/13/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • NY Medicaid: 01643645

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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