Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

1717 Medical PC

Organization Sports Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1467134684

1717 Medical PC is a Sports Medicine (Physical Medicine & Rehabilitation) Physician in Islandia, New York. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1717 Veterans Memorial Hwy Ste 1
Islandia, NY 11749-1532
Phone: (631) 203-4300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Physical Medicine & Rehabilitation) Physician (primary) Taxonomy 2081S0010X

Record details

NPI number1467134684
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jordan Sudberg — Owner · (631) 482-2754
NPI enumeratedAugust 7, 2023
Last updated in NPPESAugust 7, 2023
Certification dateAugust 7, 2023
Mailing address1717 Veterans Memorial Hwy Ste 1, Islandia, NY 11749-1532

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