Individual
DR. JERRY NINIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4 ROOSEVELT AVE, PORT JEFFERSON STATION, NY 11776-3363
(631) 331-0500
(631) 331-1644
Mailing address
4 ROOSEVELT AVE, PORT JEFFERSON STATION, NY 11776-3363
(631) 331-0500
(631) 331-1644
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
174810
NY
207V00000X
Obstetrics & Gynecology Physician
Primary
174810
NY
Other
Enumeration date
07/19/2005
Last updated
04/27/2017
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