JOHN T MATHER MEMORIAL HOSPITAL (NPI# 1265844716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265844716 |
| Entity Type | Organization |
| Organization Name | JOHN T MATHER MEMORIAL HOSPITAL |
| Other Organization Name | MEDICAL WEIGHT MANAGEMENT |
| Practice Address |
625 Belle Terre Rd Suite 203 Port Jefferson NY 11777-2316 |
| Practice Telephone | 6316867897 |
| Practice Fax Number | 6316862503 |
| Mailing Telephone | 6316867897 |
| Mailing Fax Number | 6316862503 |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2014-08-27 |
| Authorized Official Name | MR. JOSEPH WISNOSKI (VP FINANCE) |
| Authorized Official Telephone | 6314731320 |
| Authorized Official Credential | CFO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
Dietary & Nutritional Service Providers |
| Other Name | Type Code |
|---|---|
| Medical Weight Management | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750740437 | John T Mather Memorial Hospital | General Acute Care Hospital | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2016-02-23 |
| 1366816894 | John T Mather Memorial Hospital | Internal Medicine | 75 N Country Rd, Suite 201, Port Jefferson, NY 11777-2119 | 2015-11-20 |
| 1922486182 | John T Mather Memorial Hospital | Physical Medicine & Rehabilitation | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2015-05-08 |
| 1881082691 | John T Mather Memorial Hospital | General Acute Care Hospital | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2014-12-31 |
| 1417355587 | John T Mather Memorial Hospital | Physical Therapist | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2014-12-05 |
| 1427280353 | John T Mather Memorial Hospital | Surgery | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2009-08-11 |
| 1821244757 | John T Mather Memorial Hospital | General Acute Care Hospital | 75 N Country Rd, Port Jefferson, NY 11777-2119 | 2008-08-12 |
| Street Address |
625 BELLE TERRE RD SUITE 203 |
| City | PORT JEFFERSON |
| State | NY |
| Zip Code | 11777-2316 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033102280 | Dinesh Shukla | Psychiatry & Neurology | 625 Belle Terre Rd, Suite 205, Port Jefferson, NY 11777-2316 | 2005-08-23 |
| 1952940942 | Katherine Rosangela Quezada | Nurse Practitioner | 625 Belle Terre Rd, Port Jefferson, NY 11777-2316 | 2019-12-23 |
| 1477093383 | Ryan Fuellbier | Physician Assistant | 625 Belle Terre Rd, 202, Port Jefferson, NY 11777-2316 | 2017-02-27 |
| 1811275548 | Ella Rosenbloom | Internal Medicine | 625 Belle Terre Rd, Port Jefferson, NY 11777-2316 | 2011-07-29 |
| 1780983395 | Advanced Laparoscopic Bariatric and General Surgery | Surgery | 625 Belle Terre Rd, Suite 202, Port Jefferson, NY 11777-2316 | 2011-03-22 |
| 1982848156 | Ashish Agarwala | Surgery | 625 Belle Terre Rd, Suite 202, Port Jefferson, NY 11777-2316 | 2009-05-01 |
| 1447414370 | North Suffolk Surgical Assoc | Specialist | 625 Belle Terre Rd, Suite 201, Port Jefferson, NY 11777-2316 | 2008-07-10 |
| 1013182112 | Michelle Marilyn Craddock | Family Medicine | 625 Belle Terre Rd, Suite 119 Port Jefferson Medical Assoc, Port Jefferson, NY 11777 | 2008-04-29 |
| 1306929716 | S Chandra Shekher | Psychiatry & Neurology | 625 Belle Terre Rd, Suite 211, Port Jefferson, NY 11777 | 2006-10-23 |
| 1659313690 | Arif Ahmad | Surgery | 625 Belle Terre Rd, Suite 202, Port Jefferson, NY 11777-2316 | 2006-06-12 |
| Find all providers in the same location | ||||
| 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 | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891308276 | Jennifer Nicole Arnette | Dietitian, Registered | 1207 Delaware Ave Ste 114, Buffalo, NY 14209-1458 | 2020-08-26 |
| 1487200358 | Jackie Carlson, Rd, Ldn, Cde Diabetes Consultant, LLC | Dietitian, Registered | 4867 College St, Ashville, NY 14710-9603 | 2019-08-15 |
| 1093219586 | Nutrition Link Services, LLC | Dietitian, Registered | 50 Jeanne Dr, Newburgh, NY 12550-1701 | 2018-03-20 |
| 1275037749 | Jo Ann Brown | Dietitian, Registered | 2233 Caton Ave Apt 6a, Brooklyn, NY 11226-2588 | 2018-03-20 |
| 1881101954 | Western New York Integrated Care Collaborative, Inc. | Dietitian, Registered | 742 Delaware Avenue, Buffalo, NY 14209 | 2018-01-10 |
| 1770994741 | Juliana Martinez | Dietitian, Registered | 430 West 34th St, Apt. 3k, New York, NY 10001-2310 | 2014-05-13 |
| 1912338120 | Kelly Elaine Gumpel | Dietitian, Registered | 60 Paulding Ave, Tarrytown, NY 10591-5713 | 2013-12-13 |
| 1467898528 | Ilona Ginevic | Dietitian, Registered | One Gustave L. Levy Place, Box 1497, New York, NY 10029 | 2013-05-16 |
| 1114286887 | Ilene Frischer | Dietitian, Registered | 560 Northern Blvd Suite207, Great Neck, NY 11021 | 2012-05-15 |
| 1033492582 | His Rhema Nutrition Services, LLC | Dietitian, Registered | 9050 Parsons Blvd Ste 304, Jamaica, NY 11432-6052 | 2011-09-21 |
| Find all providers with the same taxonomy | ||||
| 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.