Provider Demographics
NPI:1972662146
Name:VENTURA, JOSE J (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:J
Last Name:VENTURA
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8809
Mailing Address - Country:US
Mailing Address - Phone:631-687-4200
Mailing Address - Fax:631-687-4237
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8809
Practice Address - Country:US
Practice Address - Phone:631-687-4200
Practice Address - Fax:631-687-4237
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003310363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z882086081Medicare ID - Type Unspecified
S53648Medicare UPIN