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NPI Code Detail

MEDICARE: PORT JEFFERSON PEDIATRICS

MEDICARE: PORT JEFFERSON PEDIATRICS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1609994722
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORT JEFFERSON PEDIATRICS
Provider Business Mailing Address
First Line : 12 MEDICAL DR
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-1588
Country : US
Telephone Number : 631-331-1710
Fax Number : 631-331-9069
Provider Business Practice Location Address
First Line : 12 MEDICAL DR
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-1588
Country : US
Telephone Number : 631-331-1710
Fax Number : 631-331-9069
Authorized Official
Title or Position : DOCTOR
Name : MR. MARTIN KAPLAN
Credential :
Telephone Number : 631-331-1710
Provider Enumeration Date : 03/27/2007
Last Update Date : 08/22/2020

Similar Medicare Providers

1083695233 — KATHERINE G ROTH MD
Practice Location Address:
12 MEDICAL DR , STE D
PORT JEFFERSON STATION, NY
11776-1588
Practice Phone: 631-928-1222
Practice Fax: 631-928-8605
1780654178 — DR. MARTIN P KAPLAN MD
Practice Location Address:
12 MEDICAL DR
PORT JEFFERSON STATION, NY
11776-1588
Practice Phone: 631-331-1710
Practice Fax: 631-928-4910
1750468435 — THEODORE GOLDBERG M.D.
Practice Location Address:
12 MEDICAL DR
PORT JEFFERSON STATION, NY
11776-1588
Practice Phone: 631-331-4400
Practice Fax:
1699852384 — DREUX PATTON M.D.
Practice Location Address:
12 MEDICAL DR
PORT JEFFERSON STATION, NY
11776-1588
Practice Phone: 631-331-4400
Practice Fax:
1225197866 — MS. JACQUELINE PANDOLFI N.P.
Practice Location Address:
12 MEDICAL DR
PORT JEFFERSON STATION, NY
11776-1588
Practice Phone: 631-331-4400
Practice Fax: 631-331-3190
1891859567 — WENDY FARRAR RN, NP, -C, MS
Practice Location Address:
12 MEDICAL DR
PORT JEFFERSON STATION, NY
11776-1588
Practice Phone: 631-331-4400
Practice Fax:

Directions to “PORT JEFFERSON PEDIATRICS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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