NPI 1356618615

Varicose Vein Medical Office PC

Organisation Phlebology Physician Port Jefferson, NY

Practice location

Address: 405 E Main St, Port Jefferson, NY 11777-1868
Phone: (631) 474-1414
Fax: (631) 474-2032

Authorised official

Name: Jerry Ninia
Title: Owner
Phone: (631) 474-1414

Registered specialties

Phlebology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 202K00000X Licence 174810 (NY)

Other Phlebology providers in New York →

Registry record

NPI: 1356618615
Entity type: Organization
NPI issued: 30 Nov 2011
Record last updated: 30 Nov 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.