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General NPI Number Information
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NPI Number | 1881134815
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Entity Type | Organization
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Legal Business Name | PORT JEFFERSON ASC, LLC
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 1500 ROUTE 112 BLDG 3
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776
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Country | US
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Telephone | 720-287-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 ROUTE 112 BLDG 3
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8054
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Country | US
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Telephone | 631-828-5555
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Fax | 631-828-5544
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Authorized Official
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Title or Position | MANAGER
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Name | LISA A AUSTIN
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Credential |
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Telephone | 631-828-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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