Healthcare Provider Details

I. General information

NPI: 1740241884
Provider Name (Legal Business Name): LONG ISLAND BONE AND JOINT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 BELLE TERRE RD SUITE #204
PORT JEFFERSON NY
11777-1935
US

IV. Provider business mailing address

635 BELLE TERRE RD SUITE #204
PORT JEFFERSON NY
11777-1935
US

V. Phone/Fax

Practice location:
  • Phone: 631-474-0008
  • Fax: 631-474-0224
Mailing address:
  • Phone: 631-474-0008
  • Fax: 631-474-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN POJE
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-474-0008