Provider Demographics
NPI:1730605510
Name:PORT JEFFERSON MEDICAL CARE WELLNESS PLLC
Entity type:Organization
Organization Name:PORT JEFFERSON MEDICAL CARE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TROPE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-554-1024
Mailing Address - Street 1:100 MIDDLETON RD APT 42
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3923
Mailing Address - Country:US
Mailing Address - Phone:718-554-1024
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1589
Practice Address - Country:US
Practice Address - Phone:631-882-0241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty