Healthcare Provider Details

I. General information

NPI: 1841334968
Provider Name (Legal Business Name): PORT JEFFERSON EMERGENCY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S JERSEY AVE SUITE 1
SETAUKET NY
11733-2065
US

IV. Provider business mailing address

PO BOX 438
PORT JEFFERSON NY
11777-0438
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-2700
  • Fax:
Mailing address:
  • Phone: 631-689-2700
  • Fax: 631-689-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM KONCZYNIN
Title or Position: MD
Credential: MD
Phone: 631-689-2700