1717 Medical PC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

Legal business name

1717 MEDICAL PC

Practice address

1717 Veterans Memorial Hwy Ste 1
Islandia, NY 11749-1532

Phone

(631) 203-4300

NPI assigned

Aug 7, 2023

Last updated

Aug 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jordan Sudberg, MDNPI 1053577312

Title

Owner

Phone

(631) 482-2754

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Jordan Sudberg, M.D

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Islandia, NY
  • NPI 1053577312
  Authorized official Same address or phone
• Sylvera Cuerpo Voskamp, PT

  • Physical Therapist
  • Commack, NY
  • NPI 1275050221
  NPD

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691366400000",
    "number": "1467134684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 VETERANS MEMORIAL HWY STE 1",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117491532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 VETERANS MEMORIAL HWY STE 1",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117491532",
            "telephone_number": "631-203-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1717 MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-07",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A",
        "authorized_official_last_name": "SUDBERG",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-482-2754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Islandia, NY
• Providers in Islandia, NY by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.