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Organization
PORT JEFFERSON ASC, LLC
Active
Organization
PORT JEFFERSON ASC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A AUSTIN (MANAGER)
(631) 828-5555
Entity
Organization
Contact information
Practice address
1500 ROUTE 112, BLDG 3, PORT JEFFERSON STATION, NY 11776
(720) 287-5362
Mailing address
1500 ROUTE 112 BLDG 3, PORT JEFFERSON STATION, NY 11776-8054
(631) 828-5555
(631) 828-5544
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
02/23/2017
Last updated
07/20/2018
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