# NORTHEASTERN THORACIC SURGERY, PLLC

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

## Provider details

- **NPI number:** 1558054759
- **Authorized official:** GREGORY BREVETTI (OWNER/PROVIDER)
- **Authorized official phone:** (917) 575-8907

## Contact information

- **Practice address:** 1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776-8055
- **Practice address phone:** (631) 353-0909
- **Mailing address:** 1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776-8055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2023
- **Last updated:** 06/01/2023