Organization
VARICOSE VEIN MEDICAL OFFICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY NINIA MD (OWNER)
(631) 474-1414
Entity
Organization
Contact information
Practice address
405 E MAIN ST, PORT JEFFERSON, NY 11777-1868
(631) 474-1414
(631) 474-2032
Mailing address
405 E MAIN ST, PORT JEFFERSON, NY 11777-1868
(631) 474-1414
(631) 474-2032
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
174810
NY
Other
Enumeration date
11/30/2011
Last updated
11/30/2011
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