Port Jefferson Surgical PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PORT JEFFERSON SURGICAL PC

Doing business as

Port MD Medical Wellness

Practice address

1227 Main St Ste 101
Port Jefferson, NY 11777-2227

Phone

(718) 554-1042

NPI assigned

Apr 9, 2019

Organization subpart

No

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

Authorized official

Name

Markella Christakis

Title

Billing

Phone

(631) 403-4310

Specialties & licenses 1

Addresses

Other names 1

• Port MD Medical Wellness Doing business as

Locations

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569888000000",
    "number": "1912460791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 N COUNTRY RD STE 201",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 MAIN ST STE 101",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772227",
            "telephone_number": "718-554-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JEFFERSON SURGICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-10-01",
        "status": "A",
        "authorized_official_last_name": "CHRISTAKIS",
        "authorized_official_first_name": "MARKELLA",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "631-403-4310"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port MD Medical Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Port Jefferson Allergy & Asthma P.C
• Port Jefferson Dental Group P. C.
• Port Jefferson Ekg Associates
• Port Jefferson OBGYN PC
• Port Jefferson Operating LLC
• Port Jefferson Ufsd
• Port Neurology PC
• Port Radiation Therapy PC
• Reid Portnoy, DO
• Richard Poveromo, LCSW, CCM, HEC-C

• Clinic/Center in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; 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.