NPIMap

Organization Active NPI

Long Island Digestive Endoscopy Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Port Jefferson Station, NY
National Provider Identifier
1235551052
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
LONG ISLAND DIGESTIVE ENDOSCOPY CENTER, LLC
Practice address
1500 Route 112
BLDG 5
Port Jefferson Station, NY 11776-8054
Phone
(631) 828-3400
Fax
(631) 828-3244
NPI assigned
Jan 14, 2014
Last updated
Oct 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

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

Authorized official

Name
Nina Elisabeth Esperance
Title
Ceo
Phone
(631) 828-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

1500 Route 112
BLDG 5
Port Jefferson Station, NY 11776-8054

Mailing address

1500 Route 112 BLDG 5
Port Jefferson Station, NY 11776-8055
Phone (631) 828-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140701000364 NY Part B Supplier - Ambulatory Surgical Center 3971728221 Receives reassigned benefits from 63 practitioners
Practice locations: Port Jefferson Station, NY

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Long Island Digestive Endoscopy CenterCCN 33C0001143
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1501 Rte 112 BLDG 5
Port Jefferson Station, NY 11776

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1235551052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112 BLDG 5",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768055",
            "telephone_number": "631-828-3400",
            "fax_number": "631-828-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 ROUTE 112",
            "address_2": "BLDG 5",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117768054",
            "telephone_number": "631-828-3400",
            "fax_number": "631-828-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND DIGESTIVE ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-14",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "ESPERANCE",
        "authorized_official_first_name": "NINA",
        "authorized_official_middle_name": "ELISABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "631-828-3400"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson Station, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.