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SETAUKET PRIMARY MEDICAL CARE PC
NPI 1649369067
Nurse Practitioner - Family in East Setauket, NY

Active since October 12, 2006CLIA 33D1100954 · Waiver
12 BREWSTER LN, EAST SETAUKET, NY 11733(631) 941-4480(631) 941-4054 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Setauket Primary Medical Care Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SETAUKET PRIMARY MEDICAL CARE PC (NPI 1649369067) is a healthcare organization registered as a family in East Setauket, New York and active in the NPI registry since October 2006. The organization holds a CLIA Waiver certificate valid through June 16, 2027 and lists Tanya Adams, Owner, as its authorized official.

NPPES Registry Identity

NPI1649369067
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameSETAUKET PRIMARY MEDICAL CARE PC
Location Address12 BREWSTER LNEast Setauket, NY 11733-2922
Mailing Address12 Brewster LnEast Setauket, NY 11733-2922 · (631) 941-4480 · Fax (631) 941-4054
Phone(631) 941-4480
Fax(631) 941-4054
Organization SubpartNo
Authorized OfficialTanya AdamsOwner · (631) 941-4480
Enumeration DateOctober 12, 2006
Last NPPES UpdateSeptember 11, 20252 updates tracked since enumeration
✔ NPI 1649369067 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in NY · F3040001✔ Licensed in NY · 4893961✔ Licensed in NY · F334091
Also ListedFamily MedicineTaxonomy 207Q00000X · License 2278671 (NY)
12 BREWSTER LN, East Setauket, NY 11733
Open in Google Maps ↗

Other Identifiers 1

OtherDC2402NY · Medicare Rail Road

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D1100954

Setauket Primary Medical Care · Setauket, NY
Active · expires Jun 16, 2027
CLIA Number33D1100954
Laboratory TypePhysician Office
Certificate Effective DateJune 17, 2025
Certificate Expiration DateJune 16, 2027
Laboratory DirectorDr. Tanya Roth-Adams
Laboratory Phone(631) 331-3400
Laboratory LocationSetauket Primary Medical Care200 Main Street, Suite 5, Setauket, NY 11733
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JENNIFER DOOLAN NP
Nurse Practitioner (Adult Health)
12 BREWSTER LN
EAST SETAUKET, NY 11733
Suffolk County (631) 941-4480
ROBERT J LONG FNP
Nurse Practitioner (Family)
12 BREWSTER LN
EAST SETAUKET, NY 11733
Suffolk County (631) 941-4480

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Setauket Primary Medical Care PC's NPI number?

The NPI number for Setauket Primary Medical Care PC is 1649369067. It was assigned to this organization in the NPPES registry on October 12, 2006.

Where is Setauket Primary Medical Care PC located?

Setauket Primary Medical Care PC is located at 12 Brewster Ln, East Setauket, NY 11733. The listed phone number is (631) 941-4480.

What is Setauket Primary Medical Care PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Setauket Primary Medical Care PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D1100954) is associated with this NPI, valid through June 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Setauket Primary Medical Care PC was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.