Three Village Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

THREE VILLAGE MEDICINE PC

Practice address

24 Jefferson Landing Cir
Port Jefferson, NY 11777-1978

Phone

(516) 946-0000

NPI assigned

Mar 21, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Syed Shabahat Hussain, MDNPI 1629269675

Title

Ceo

Phone

(516) 946-0000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Syed Hussain

  • Adult Medicine Physician
  • West Brentwood, NY
  • NPI 1629269675
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521590400000",
    "number": "1982108353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 JEFFERSON LANDING CIR",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771978",
            "telephone_number": "516-946-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 JEFFERSON LANDING CIR",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771978",
            "telephone_number": "516-946-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE VILLAGE MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2018-03-21",
        "status": "A",
        "authorized_official_last_name": "HUSSAIN",
        "authorized_official_first_name": "SYED",
        "authorized_official_middle_name": "SHABAHAT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "516-946-0000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.