# DR. JERRY NINIA OB-GYN PLLC

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

## Provider details

- **NPI number:** 1811127632
- **Authorized official:** DR. JERRY NINIA (SOLE PROPRIETOR)
- **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
- **Practice address fax:** (631) 331-1644
- **Mailing address:** 1 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1599
- **Mailing address phone:** (631) 331-0500
- **Mailing address fax:** (631) 331-1644

## Taxonomy

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

## Other

- **Enumeration date:** 07/15/2009
- **Last updated:** 08/25/2010