Port Radiation Therapy Pc

LBN: Port Radiation Therapy Pc
Port Radiation Therapy Pc is an health care organization with primary practice located at 75 N Country Rd , 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 Radiation Therapy Pc can be contacted via phone (631) 476-2757, or through Glenn, Edward H via phone (631) 476-2757.

Contact Information

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

Health care specialties

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

Profile Details

NPI number 1356412035
LBN Legal business name Port Radiation Therapy Pc
DBA Doing business as
Authorized official Glenn, Edward H Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Nov 13th, 2006
Last updated Aug 22nd, 2020 - about 5 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 1356412035 NPPES
New York MEDICAID 01643645

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