PORT INTERVENTIONAL RADIOLOGY PC (NPI# 1164434924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164434924 |
| Entity Type | Organization |
| Organization Name | PORT INTERVENTIONAL RADIOLOGY PC |
| Practice Address |
75 North Country Road Port Jefferson NY 11777 |
| Practice Telephone | 6314762757 |
| Practice Fax Number | 6314730132 |
| Mailing Telephone | 6314762757 |
| Mailing Fax Number | 6314730132 |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | EDWARD H GLENN (PRESIDENT) |
| Authorized Official Telephone | 6314762754 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01643636 | 05 |
| Street Address |
75 NORTH COUNTRY ROAD |
| City | PORT JEFFERSON |
| State | NY |
| Zip Code | 11777 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629075387 | Imtiaz A Khokhar | Internal Medicine | 75 North Country Road, Port Jefferson, NY 11777 | 2005-07-07 |
| 1700318821 | Kirolos Ibrahim | Student in an Organized Health Care Education/Training Program | 75 North Country Road, Mather Hospital Gme, Port Jefferson, NY 11777 | 2017-03-29 |
| 1619989464 | Professional Radiology PC | Radiology | 75 North Country Road, Port Jefferson, NY 11777 | 2006-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568088615 | Aqsa Ashraf | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mather Hospital Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-24 |
| 1366068975 | Manal Ahmad | Student in an Organized Health Care Education/Training Program | 75 N County Rd, Level 2 Cmo Suite, Internal Medicine Re, Mather Hospital, Port Jefferson, NY 11777 | 2020-06-19 |
| 1639794555 | Umair Ahmad Ansari | Student in an Organized Health Care Education/Training Program | 75 N Country Road Mother Hospital, Internal Medicine Re, Level 2 - Cmd Suite, Port Jefferson, NY 11777 | 2020-06-16 |
| 1578188132 | Manasi Sule | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Mather Hospital, Internal Medicine Res, Port Jefferson, NY 11777 | 2020-06-10 |
| 1508480716 | Imona Subedi | Student in an Organized Health Care Education/Training Program | 75 N Country Road, Level 2 - Cmo Suite, Mather Hospital Internal Medicine Residency Program, Port Jefferson, NY 11777 | 2020-06-03 |
| 1184252108 | Romana Imtiaz Syed | Student in an Organized Health Care Education/Training Program | Liza M Dominioni,mather Hospital,internal Medicine, Residency Program,level 2-cmo Suite,75 N Country Rd, Port Jefferson, NY 11777 | 2020-03-27 |
| 1649807348 | Mustafa Mohammed Abdulsada | Student in an Organized Health Care Education/Training Program | 75 N Country Rd, Ny, Level 2 - Cmo Suite, Port Jefferson, NY 11777 | 2020-03-24 |
| 1184264764 | Girma Moges Gamme | Surgery | 625 Belle Terre Rd, Suite 203 Mather Hospital, Port Jefferson, NY 11777 | 2020-01-10 |
| 1811554637 | Kausar Ali | Nurse Practitioner | 408 Thompson Street, Port Jefferson, NY 11777 | 2019-05-28 |
| 1073097531 | Ministry for Hope, Inc. Montfort Therapeutic Residence | Residential Treatment Facility, Physical Disabilities | 100 Stonyhill Road, Port Jefferson, NY 11777 | 2018-09-20 |
| Find all providers in zip 11777 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780858860 | Kenny Lien | Radiology | 75 N Country Road, Port Jefferson, NY 11777 | 2008-04-18 |
| 1538611876 | New York Radiology & Specialty Neuroradiology Pllc | Radiology | 450 Main St, Port Jefferson, NY 11777-1658 | 2016-11-03 |
| 1629431473 | Meghan Moriarty | Radiology | 75 N Country Rd, Port Jefferson, NY 11777 | 2016-03-30 |
| 1336428796 | John T. Mather Memorial Hospital | Radiology | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2011-08-16 |
| 1306145057 | Reubin Pooya Davoudzadeh | Radiology | 200 Belle Terre Rd, Port Jefferson, NY 11777-1928 | 2011-03-21 |
| 1891816070 | John T. Mather Memorial Hospital | Radiology | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2007-04-03 |
| 1356412035 | Port Radiation Therapy PC | Radiology | 75 N Country Rd, Port Jefferson, NY 11777 | 2006-11-13 |
| 1194812479 | John T. Mather Memorial Hospital | Radiology | 120 N Country Rd, Port Jefferson, NY 11777-2604 | 2006-10-06 |
| 1619989464 | Professional Radiology PC | Radiology | 75 North Country Road, Port Jefferson, NY 11777 | 2006-08-12 |
| 1629080478 | Michelle P Price | Radiology | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2006-08-12 |
| Find all providers in PORT JEFFERSON | ||||
| City | PORT JEFFERSON |
| Zip Code | 11777 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.