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

Individual provider Obstetrics & Gynecology Physician · NPI 1457350795

Dr. Jerry Ninia, MD is an Obstetrics/Gynecology in Port Jefferson Station, New York. Qualified in 1987, 39 years ago. Practices with Square Care Medical Group LLP, a 72-clinician group. Licensed in New York.

Years since qualifying
39
Licensed in
NY
In the registry since
2005
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4 Roosevelt Ave
Port Jefferson Station, NY 11776-3363
Phone: (631) 331-0500
Fax: (631) 331-1644
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence 174810 (NY)
Phlebology Physician Taxonomy 202K00000X · Licence 174810 (NY)

Record details

NPI number1457350795
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJuly 19, 2005
Last updated in NPPESApril 27, 2017

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolOTHER
Graduated 1987 (39 years in practice)
Group practice Square Care Medical Group Llp — 72 clinicians
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

Other providers in Port Jefferson Station