NPIMap

Organization Active NPI

Port Neurology PC

  • Specialist
  • Port Jefferson, NY
National Provider Identifier
1417024001
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
196859 Issued in NY
Legal business name
PORT NEUROLOGY PC
Practice address
640 Belle Terre Rd
Building H
Port Jefferson, NY 11777-1936
Phone
(631) 331-8774
Fax
(631) 331-8775
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Authorized official

Name
Dr. Ajay V Berdia, M.D.
Title
President
Phone
(631) 331-8774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 196859 NY Primary

Addresses

Primary practice location

640 Belle Terre Rd
Building H
Port Jefferson, NY 11777-1936

Mailing address

640 Belle Terre Rd
Building H
Port Jefferson, NY 11777-1936
Phone (631) 331-8774

National Provider Directory

National Provider Directory

Locations

640 Belle Terre Rd
Bldg H
Prt Jefferson, NY 11777
Phone (516) 331-8775

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1417024001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 BELLE TERRE RD",
            "address_2": "BUILDING H",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771936",
            "telephone_number": "631-331-8774",
            "fax_number": "631-331-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 BELLE TERRE RD",
            "address_2": "BUILDING H",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771936",
            "telephone_number": "631-331-8774",
            "fax_number": "631-331-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT NEUROLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "BERDIA",
        "authorized_official_first_name": "AJAY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-331-8774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "196859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.