Port Interventional Radiology Pc

LBN: Port Interventional Radiology Pc
Port Interventional Radiology Pc is an health care organization with primary practice located at 75 North Country Road , Port Jefferson NY 11777. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as the primary health care specialty. Port Interventional Radiology Pc can be contacted via phone (631) 476-2757, or through Glenn, Edward H via phone (631) 476-2754.

Contact Information

Primary practice address
75 North Country Road Port Jefferson NY 11777
Phone: (631) 476-2757
Fax: (631) 473-0132
Website:
Map and Directions
Authorized official contact:
Name: Glenn, Edward H Doctor of Medicine (MD)
Phone: (631) 476-2754

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X

Profile Details

NPI number 1164434924
LBN Legal business name Port Interventional Radiology Pc
DBA Doing business as
Authorized official Glenn, Edward H Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 12th, 2006
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164434924 NPPES
New York MEDICAID 01643636

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