Organization
JERRY G NINIA MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY G NINIA (PHYSICIAN)
(631) 331-0500
Entity
Organization
Contact information
Practice address
1 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1599
(631) 331-0500
Mailing address
1 MEDICAL DR, SUITE D, PORT JEFFERSON STATION, NY 11776-1599
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
174810
NY
Other
Enumeration date
02/02/2011
Last updated
02/02/2011
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