BV Port Jefferson Operator, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BV PORT JEFFERSON OPERATOR, LLC

Doing business as

Brightview Port Jefferson

Practice address

1175 Route 112
Port Jefferson Station, NY 11776

Phone

(631) 802-5021

Fax

(631) 802-5022

NPI assigned

Jan 5, 2022

Organization subpart

No

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

Authorized official

Name

Marilynn Duker

Title

President / Duker

Phone

(410) 962-0595

Specialties & licenses 2

Addresses

Other names 1

• Brightview Port Jefferson Doing business as

Locations

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

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1649931254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-802-5021",
            "fax_number": "631-802-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "631-802-5021",
            "fax_number": "631-802-5022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BV PORT JEFFERSON OPERATOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "DUKER",
        "authorized_official_first_name": "MARILYNN",
        "authorized_official_title_or_position": "PRESIDENT / DUKER",
        "authorized_official_telephone_number": "410-962-0595"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brightview Port Jefferson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Angelo Buonomo I, MS.ED.,PH.D.
• Jennifer Burdish
• Fern M Burke, LPN
• William Burke, R.PH.
• Stephanie Bux, MA CCC-SLP
• Valentina Cabebe
• Francine Cacciola, MSOT OTR/L
• Eileen Alanna Caffery, LCSW
• Allison Calamia, LAC
• Lindsey Michelle Callan

• Assisted Living Facility in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Assisted Living Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; 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.