NORTHEASTERN THORACIC SURGERY, PLLC
NPI 1558054759
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Port Jefferson Station, NY

Q: What is the provider's specialty?

The provider's specialty is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

Active since June 01, 2023

1500 ROUTE 112 STE B, PORT JEFFERSON STATION, NY 11776(631) 353-0909 Get Directions Write a Review

NPPES record last updated: June 1, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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NPI Profile Information
Primary Taxonomy
Group Taxonomy
Authorized Official
Other Providers Same Location
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Organization
Thoracic Surgery (Cardiothoracic Vascula...

About NORTHEASTERN THORACIC SURGERY, PLLC

This page provides the complete NPI Profile along with additional information for Northeastern Thoracic Surgery, Pllc, a provider established in Port Jefferson Station, New York operating as a Thoracic Surgery (cardiothoracic Vascular Surgery). The healthcare provider is registered in the NPI registry with number 1558054759 assigned on June 2023. The practitioner's primary taxonomy code is 208G00000X. The provider is registered as an organization and their NPI record was last updated 3 years ago. Northeastern Thoracic Surgery, Pllc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Gregory Brevetti (Owner/provider)

NPI: 1558054759 Verify this NPI
Provider Name: NORTHEASTERN THORACIC SURGERY, PLLC
Entity Type: Organization
Location Address: 1500 ROUTE 112 STE B PORT JEFFERSON STATION, NY 11776
Location Phone: (631) 353-0909
Mailing Address: 1500 ROUTE 112 STE B PORT JEFFERSON STATION, NY 11776
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 06-01-2023
Last Update Date: 06-01-2023
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery)
Taxonomy Code: 208G00000X
Type: Allopathic & Osteopathic Physicians
Taxonomy Description: A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: GREGORY BREVETTI
Authorized Official Title: OWNER/PROVIDER
Authorized Official Phone: (917) 575-8907