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

Northeast Breast Reconstruction LLC

Organization Plastic and Reconstructive Surgery Physician · NPI 1255879748

Northeast Breast Reconstruction LLC is a Plastic and Reconstructive Surgery Physician in Southport, Connecticut. Licensed in New Jersey. Registered with an NPI since 2017.

Licensed in
NJ
In the registry since
2017
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

21 Southport Ter
Southport, CT 06890
Phone: (718) 672-2824
Fax: (718) 672-3280
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X · Licence 25MA10021400 (NJ)

Record details

NPI number1255879748
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shareef Jandali — Owner · (718) 672-2824
NPI enumeratedFebruary 6, 2017
Last updated in NPPESFebruary 6, 2017
Mailing address21 Southport Terrace, Southport, CT 06890

Other providers in Southport