John T. Mather Memorial Hospital
Organization Active NPI Nurse Practitioner · Port Jefferson, NY
NPI 1821185109 · NPPES record last updated Apr 29, 2015
Key facts
- NPI
- 1821185109
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- JOHN T. MATHER MEMORIAL HOSPITAL
- Practice address
- 75 N Country Rd
Port Jefferson, NY 11777-2119 - Phone
- (631) 473-1320
- Fax
- (631) 686-7972
- NPI assigned
- Oct 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Joseph Wisnoski
- Title
- Vice President Finance
- Phone
- (631) 473-1320
Other NPIs on the same Medicare enrollment 14
Practitioners 35
-
Lisa Ambrose, NP
-
Hyon Jin Bae, FNP
-
Brian Barnett, PA
-
Laura Bell, NP
-
John-Paul Blaber, M.D.
-
Bo Chao, M.D.
-
Melinda Clarke, MS, RN, FNP, PMHNP
-
Cynthia Ellen Cohen, MSN, ANP-BC
-
Marilyn F Conner, CANP
-
Syed K Hussaini, M.D
-
Ateaya A Lima, MD
-
Karen K. McDonald, FNP
-
Myat Myo, M.D
-
Javeria Nasim, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040316000754 | NY | Part B Supplier - Clinic/Group Practice | 1254237753 |
Receives reassigned benefits from 318 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Port Jefferson, NY; Port Jefferson Station, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
75 N Country Rd
Port Jefferson, NY 11777-2119
Mailing address
625 Belle Terre Rd
Suite 100
Port Jefferson, NY 11777-2316
Phone (631) 473-1320
Other providers in Port Jefferson, NY
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital
- John T. Mather Memorial Hospital
- Jeena Elizabeth John
- Jency Johnikutty
- Kerry Lynn Johnson
All providers in Port Jefferson, NY · Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.