OrganizationActive
Varicose Vein Medical Office PC
NPI 1356618615 · Phlebology Physician · Port Jefferson, NY
Provider details
- NPI number
- 1356618615
- Entity type
- Organization
- Primary specialty
- Phlebology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jerry Ninia, Owner(631) 474-1414
- License
- 174810 (NY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
405 E Main St
Port Jefferson, NY 11777-1868
Phone: (631) 474-1414
Fax: (631) 474-2032
Approximate (ZIP-level) locationGet directions
Mailing address
405 E Main St
Port Jefferson, NY 11777-1868
Registry dates
- Enumerated
- 2011-11-30
- Last updated
- 2011-11-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.