John T Mather Memorial Hospital

Primary specialty

Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X

Legal business name

JOHN T MATHER MEMORIAL HOSPITAL

Practice address

625 Belle Terre Rd
Suite 203
Port Jefferson, NY 11777-2316

Phone

(631) 686-7897

Fax

(631) 686-2503

NPI assigned

Jun 2, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Joseph Wisnoski, CFO

Title

VP Finance

Phone

(631) 473-1320

Specialties & licenses 2

Addresses

Other names 1

• Medical Weight Management Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• John T. Mather Memorial Hospital

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Port Jefferson, NY
  • NPI 1073863635

  O20130103000478

  Same enrollment
• John T. Mather Memorial Hospital

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Port Jefferson, NY
  • NPI 1639585706

  O20130103000478

  Same enrollment

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• North Shore Long Island Jewish Healthcare Inc.

  • Surgery Physician
  • Westbury, NY
  • NPI 1427428150

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Irina Papp, RPA-C

  • Physician Assistant
  • Port Jefferson, NY
  • NPI 1467796334
  NPD

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

{
    "created_epoch": "1401667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409097600000",
    "number": "1265844716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 BELLE TERRE RD",
            "address_2": "SUITE 203",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772316",
            "telephone_number": "631-686-7897",
            "fax_number": "631-686-2503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 BELLE TERRE RD",
            "address_2": "SUITE 203",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772316",
            "telephone_number": "631-686-7897",
            "fax_number": "631-686-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T MATHER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-02",
        "last_updated": "2014-08-27",
        "status": "A",
        "authorized_official_last_name": "WISNOSKI",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "631-473-1320",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Weight Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jan S. Miller
• Janice Martin Licensed Clinical Social Worker PC
• Czariavna Javed, MD
• Hurline L Jeudy
• Paniz Hannah Johari, MD
• John T Mather Memorial Hospital
• John T Mather Memorial Hospital
• John T Mather Memorial Hospital
• John T Mather Memorial Hospital
• John T Mather Memorial Hospital

• Metabolic Nutrition Registered Dietitian in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Metabolic Nutrition Registered Dietitian in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; 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.