Healthcare Provider Details

I. General information

NPI: 1912988395
Provider Name (Legal Business Name): PORT EMERGENCY MEDICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BELLE TERRE RD
PORT JEFFERSON NY
11777-1968
US

IV. Provider business mailing address

12420 MILESTONE CENTER DR STE 200
GERMANTOWN MD
20876-7111
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4019
  • Fax:
Mailing address:
  • Phone: 240-686-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY CHARLEY
Title or Position: VP LEGAL
Credential: ESQ
Phone: 240-686-2300