| Village Internal Medicine Group | |
|
710 Main Street Port Jefferson NY 11777 | |
| (631) 474-4000 | |
| (631) 474-4011 |
| Full Name | Village Internal Medicine Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 710 Main Street, Port Jefferson, New York |
| Authorized Official Name and Position | Mark J. Dibenedetto (MD/PRESIDENT) |
| Authorized Official Contact | 6314744000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Internal Medicine Group 710 Main Street Village Internal Medicine Group Port Jefferson NY 11777 Ph: (631) 474-4000 | Village Internal Medicine Group 710 Main Street Port Jefferson NY 11777 Ph: (631) 474-4000 |
| NPI Number | 1003889023 |
|---|---|
| Provider Enumeration Date | 02/09/2006 |
| Last Update Date | 12/29/2010 |
| Medicare PECOS PAC ID | 8325236102 |
|---|---|
| Medicare Enrollment ID | O20120524000191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003889023 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 172308 (New York) | Primary |
| Provider Name | Mark J Dibenedetto |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619940269 PECOS PAC ID: 9638367410 Enrollment ID: I20101221000143 |
Family Medical Wellness Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 125 Oakland Ave, Ste 203, Port Jefferson, NY 11777 Phone: 631-928-9326 | |
Harbor Medical Wellness Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 640 Belle Terre Rd Bldg J, Port Jefferson, NY 11777 Phone: 631-885-2364 | |
Mather Primary Care, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 125 Oakland Ave, Suite 205, Port Jefferson, NY 11777 Phone: 631-686-2523 Fax: 631-686-2525 | |
Bariatric Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 75 N Country Rd, Suite 201, Port Jefferson, NY 11777 Phone: 631-689-0220 Fax: 631-417-3042 | |
Endocrinogy Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 125 Oakland Ave Ste 203, Port Jefferson, NY 11777 Phone: 631-686-2552 | |
Steven G Selter Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 Prospect St, Port Jefferson, NY 11777 Phone: 631-473-0611 Fax: 631-642-1617 |