Organization
PORT RADIATION THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD H GLENN MD (PRESIDENT)
(631) 476-2757
Entity
Organization
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777
(631) 476-2757
Mailing address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777
(631) 476-2757
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01643645
—
NY
Enumeration date
11/13/2006
Last updated
08/22/2020
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