PROFESSIONAL RADIOLOGY PC NPI 1619989464

NPI Information

NPI: 1619989464
Provider Name: PROFESSIONAL RADIOLOGY PC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

Address:
75 NORTH COUNTRY ROAD
PORT JEFFERSON, NY
ZIP 11777
Phone: (631) 476-2757
Get Directions

PROFESSIONAL RADIOLOGY PC is a diagnostic radiology radiology in Port Jefferson, NY. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. PROFESSIONAL RADIOLOGY PC NPI is 1619989464. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

75 NORTH COUNTRY ROAD
PORT JEFFERSON, NY
ZIP 11777
Phone: (631) 476-2757
Fax: (631) 473-0132

The provider's authorized official is Edward H Glenn .
The authorized official title is President and has the following contact phone number (631) 476-2757.

The enumeration date for this NPI number is 8/12/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00820911	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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