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Organization

PORT RADIOLOGY SERVICES PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EDWARD J GLENN MD (PRESIDENT)
(631) 351-2000
Entity
Organization

Contact information

Practice address
270 PARK AVE, HUNTINGTON, NY 11743-2787
(631) 351-2000
Mailing address
270 PARK AVE, HUNTINGTON, NY 11743-2787
(631) 351-2000

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01675658
NY
Enumeration date
08/12/2006
Last updated
08/22/2020
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