Peconic Bay Faculty Medical Affiliates, University Faculty Practice Co

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

Legal business name

PECONIC BAY FACULTY MEDICAL AFFILIATES, UNIVERSITY FACULTY PRACTICE CO

Practice address

1 Heroes Way
Riverhead, NY 11901-2054

Phone

(631) 548-6063

Fax

(631) 548-6007

NPI assigned

Jul 8, 2024

Organization subpart

No

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

Authorized official

Name

Jennifer A Meyer, NP

Title

Nurse Practicioner

Phone

(631) 548-6063

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1720396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1497591507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HEROES WAY",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012054",
            "telephone_number": "631-548-6063",
            "fax_number": "631-548-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HEROES WAY",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012054",
            "telephone_number": "631-548-6063",
            "fax_number": "631-548-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECONIC BAY FACULTY MEDICAL AFFILIATES, UNIVERSITY FACULTY PRACTICE CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NURSE PRACTICIONER",
        "authorized_official_telephone_number": "631-548-6063",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Donald Patterson, M.D.
• Pooja Paunikar
• Kristen Marie Pearsall
• John W Pearson, M.D.
• Peconic Anesthesiologist, P.C.
• Peconic Bay Medical Center
• Peconic Bay Medical Center
• Peconic Bay Medical Center
• Peconic Cardiology, PC
• Peconic Licensed Mental Health Counseling

• Acute Care Nurse Practitioner in Riverhead, NY
• Providers in Riverhead, NY by specialty
• Acute Care Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.