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Organization
PORT JEFF MEDICINE, P.C.
Active
Organization
PORT JEFF MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEEPTI GUPTA MD (PRESIDENT/OWNER)
(631) 331-5010
Entity
Organization
Contact information
Practice address
2 MEDICAL DR STE D, PORT JEFF STA, NY 11776-1598
(631) 331-5010
(631) 331-5017
Mailing address
2 MEDICAL DR STE D, PORT JEFFERSON STATION, NY 11776-1598
(631) 331-5010
(631) 331-5017
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
196816
NY
Other
Enumeration date
06/12/2017
Last updated
06/19/2017
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