# JERRY G NINIA MDPC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508162959
- **Authorized official:** DR. JERRY G NINIA (PHYSICIAN)
- **Authorized official phone:** (631) 331-0500

## Contact information

- **Practice address:** 1 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1599
- **Practice address phone:** (631) 331-0500
- **Mailing address:** 1 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 174810 | NY | Yes |

## Other

- **Enumeration date:** 02/02/2011
- **Last updated:** 02/02/2011