Organization
PROFESSIONAL RADIOLOGY 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 NORTH COUNTRY ROAD, PORT JEFFERSON, NY 11777
(631) 476-2757
(631) 473-0132
Mailing address
75 NORTH COUNTRY ROAD, PORT JEFFERSON, NY 11777
(631) 476-2757
(631) 473-0132
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00820911
—
NY
Enumeration date
08/12/2006
Last updated
08/22/2020
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