| Doctor Name: | DR. JERRY NINIA |
| NPI Number: | 1457350795 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 174810 |
| Business Practice Address: | 4 Roosevelt Ave Port Jefferson Station, NY - 117763363 |
| Business Phone Number: | 6313310500 |
| Business Fax Number: | 6313311644 |
| Mailing Address: | 4 Roosevelt Ave, PORT JEFFERSON STATION |
| State: | NY |
| Postal Code: | 117763363 |
| Phone Number: | 6313310500 |
| Fax Number: | 6313311644 |
| NPI Enumeration Date: | 07/19/2005 |
| NPI Last Update Date: | 06/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/20/2006 |
| NPI Reactivation Date: | 03/29/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 174810 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |