Port Jeff Medicine, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

196816 Issued in NY

Legal business name

PORT JEFF MEDICINE, P.C.

Practice address

2 Medical Dr Ste D
Port Jeff Sta, NY 11776-1598

Phone

(631) 331-5010

Fax

(631) 331-5017

NPI assigned

Jun 12, 2017

Organization subpart

No

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

Authorized official

Name

Deepti Gupta, MDNPI 1619936069

Title

President/Owner

Phone

(631) 331-5010

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 4

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

• Deepti Gupta, M.D.

  • Internal Medicine Physician
  • Port Jefferson Station, NY
  • NPI 1619936069
  Medicare reassignment Authorized official
• Syed Afzal

  • Family Medicine Physician
  • W Islip, NY
  • NPI 1558318550
  NPD
• Robin S Dacosta, MD

  • Internal Medicine Physician
  • Ronkonkoma, NY
  • NPI 1730306507
  NPD
• Siva K Kolupoti, M.D

  • Internal Medicine Physician
  • Port Jefferson Station, NY
  • NPI 1609809102
  NPD (past)

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

{
    "created_epoch": "1497225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497830400000",
    "number": "1346770484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MEDICAL DR STE D",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761598",
            "telephone_number": "631-331-5010",
            "fax_number": "631-331-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL DR STE D",
            "city": "PORT JEFF STA",
            "state": "NY",
            "postal_code": "117761598",
            "telephone_number": "631-331-5010",
            "fax_number": "631-331-5017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JEFF MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-12",
        "last_updated": "2017-06-19",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "DEEPTI",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "631-331-5010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "196816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mobilescan Inc.
• Jessica J Monaco
• Sheryl Nodeland, RN
• Leah M Pasquarella, RD CDN
• Meghan Katie Picciano
• Port Jefferson Therapeutic Massage P.C.
• Andrea Priamo, M.S. E.D
• Michael Victor Rella
• Judith Remigio
• Alicia Patrice Rodriguez, L.P.N.

• Internal Medicine Physician in Port Jeff Sta, NY
• Providers in Port Jeff Sta, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2017; 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.