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

Northeastern Thoracic Surgery, PLLC

Organization Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · NPI 1558054759

Northeastern Thoracic Surgery, PLLC is a Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Port Jefferson Station, New York. Registered with an NPI since 2023.

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

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Practice location Address checks out

1500 Route 112 Ste B
Port Jefferson Station, NY 11776-8055
Phone: (631) 353-0909
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (primary) Taxonomy 208G00000X

Record details

NPI number1558054759
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gregory Brevetti — Owner/Provider · (917) 575-8907
NPI enumeratedJune 1, 2023
Last updated in NPPESJune 1, 2023
Certification dateJune 1, 2023
Mailing address1500 Route 112 Ste B, Port Jefferson Station, NY 11776-8055

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