Provider Demographics
NPI:1568590115
Name:JOHN T. MATHER MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:JOHN T. MATHER MEMORIAL HOSPITAL
Other - Org Name:PORT JEFF MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP-FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:LETTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-476-2753
Mailing Address - Street 1:75 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2119
Mailing Address - Country:US
Mailing Address - Phone:631-473-1320
Mailing Address - Fax:631-473-5254
Practice Address - Street 1:120 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2604
Practice Address - Country:US
Practice Address - Phone:631-473-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5149000282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY97Z501Medicare ID - Type UnspecifiedJOINT MRI NONPROVID. BASE