Healthcare Provider Details

I. General information

NPI: 1568805224
Provider Name (Legal Business Name): PORTION CONTROLLER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 ROUTE 111 SUITE 4
SMITHTOWN NY
11787-4739
US

IV. Provider business mailing address

PO BOX 1516
SMITHTOWN NY
11787-8594
US

V. Phone/Fax

Practice location:
  • Phone: 631-574-4004
  • Fax:
Mailing address:
  • Phone: 631-574-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number175496
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number175496
License Number StateNY

VIII. Authorized Official

Name: DAVID S ASLEY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 631-574-4004