| Three Village Medicine Pc | |
|
24 Jefferson Landing Cir Port Jefferson NY 11777-1978 | |
| (516) 946-0000 | |
| Not Available |
| Full Name | Three Village Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 24 Jefferson Landing Cir, Port Jefferson, New York |
| Authorized Official Name and Position | Syed Shabahat Hussain (CEO) |
| Authorized Official Contact | 5169460000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Three Village Medicine Pc 24 Jefferson Landing Cir Port Jefferson NY 11777-1978 Ph: (516) 946-0000 | Three Village Medicine Pc 24 Jefferson Landing Cir Port Jefferson NY 11777-1978 Ph: (516) 946-0000 |
| NPI Number | 1982108353 |
|---|---|
| Provider Enumeration Date | 03/21/2018 |
| Last Update Date | 03/21/2018 |
| Medicare PECOS PAC ID | 9436413051 |
|---|---|
| Medicare Enrollment ID | O20180508001499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982108353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Syed Hussain |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1629269675 PECOS PAC ID: 8729265947 Enrollment ID: I20110615000324 |
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