Varicose Vein Medical Office PC

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

17481001 Issued in NY

Legal business name

VARICOSE VEIN MEDICAL OFFICE PC

Practice address

405 E Main St
Port Jefferson, NY 11777-1868

Phone

(631) 474-1414

NPI assigned

Jul 16, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carolyn Healy

Title

Manager

Phone

(631) 331-0500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Varicose Vein Medical Office PC

  • Phlebology Physician
  • Port Jefferson, NY
  • NPI 1356618615

  O20150710000658

  Same enrollment

Tax ID family

Varicose Vein Medical Office PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Varicose Vein Medical Office PC

  • Phlebology Physician
  • Port Jefferson, NY
  • NPI 1356618615
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426464000000",
    "number": "1174753875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 E MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771868",
            "telephone_number": "631-474-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E MAIN ST",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771868",
            "telephone_number": "631-474-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VARICOSE VEIN MEDICAL OFFICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2015-03-16",
        "status": "A",
        "authorized_official_last_name": "HEALY",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "631-331-0500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Phlebology",
            "state": "NY",
            "license": "17481001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Urological Associates of Li, PC
• Anzhelika Vaccaro, MD
• Mary Jane Vacirca, MS, PT
• John Mark Vanburik
• Regina Catherine Varacchi, RN
• Varicose Vein Medical Office PC
• Aakaash Varma, MD
• Jessie Vessichio, MA CAGS
• Kristen Jeanne Vetrano, NP
• Whitney Michelle Viator, MD

• Phlebology Physician in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Phlebology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.