Provider Demographics
NPI:1740241884
Name:LONG ISLAND BONE AND JOINT
Entity Type:Organization
Organization Name:LONG ISLAND BONE AND JOINT
Other - Org Name:PORT JEFFERSON SPECIALTY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-474-0008
Mailing Address - Street 1:635 BELLE TERRE RD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1935
Mailing Address - Country:US
Mailing Address - Phone:631-474-0008
Mailing Address - Fax:631-474-0224
Practice Address - Street 1:635 BELLE TERRE RD
Practice Address - Street 2:SUITE #204
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1935
Practice Address - Country:US
Practice Address - Phone:631-474-0008
Practice Address - Fax:631-474-0224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG ISLAND BONE AND JOINT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08816Medicare UPIN
NY341171Medicare ID - Type Unspecified
NY05F711Medicare ID - Type Unspecified
NYD91916Medicare UPIN
NYG68749Medicare UPIN
NYH41912Medicare UPIN
NY79G771Medicare ID - Type Unspecified
NY556G31Medicare ID - Type Unspecified
NY3R4961Medicare ID - Type Unspecified
NYWX0221Medicare ID - Type Unspecified
NYH13342Medicare UPIN
NYF22448Medicare UPIN
NY404F31Medicare ID - Type Unspecified
1286620002Medicare NSC