Provider Demographics
NPI:1114001120
Name:PORT JEFF SPECIFIC CHIROPRACTIC
Entity Type:Organization
Organization Name:PORT JEFF SPECIFIC CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:V
Authorized Official - Last Name:MASONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-476-7330
Mailing Address - Street 1:PO BOX 5140
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1104
Mailing Address - Country:US
Mailing Address - Phone:631-473-7330
Mailing Address - Fax:631-642-9242
Practice Address - Street 1:29 MILLER WOODS DR
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1524
Practice Address - Country:US
Practice Address - Phone:631-473-7330
Practice Address - Fax:631-642-9242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty