# JOHN T MATHER MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Back and Neck Pain Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922486182
- **Authorized official:** MRS. SHARON DONNELLY (PROJECT DIRECTOR)
- **Authorized official phone:** (631) 473-1320

## Contact information

- **Practice address:** 75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
- **Practice address phone:** (631) 473-1320
- **Practice address fax:** (631) 686-7972
- **Mailing address:** 75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
- **Mailing address phone:** (631) 473-1320
- **Mailing address fax:** (631) 686-7972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/08/2015
- **Last updated:** 05/08/2015