Look up the most recent NPI and PECOS records

Justin Larson

Emergency Medicine

Allopathic & Osteopathic Physicians

101 Nicolls Rd, Stony Brook, NY 11794-0001

PECOS Enrollment

Based on the most recent information from CMS, provider Justin Larson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1952833816
Provider Type
Individual
Full Name
Larson, Justin
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
3/30/2017
Last Updated
8/11/2020

Contact Information

Practice Location

101 Nicolls Rd, Stony Brook, NY 11794-0001

(631) 689-8333

Unlisted Fax

Mailing Location

101 Nicolls Rd, Stony Brook, NY 11794-0001

(631) 689-8333

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 036150740 Illinois
Code 207P00000X	Description Emergency Medicine Allopathic & Osteopathic Physicians	License 01083756A Indiana

Justin Larson

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Leonard, Marshall

Chale, Stuart

Kotelnik, Vladimir

Taglienti, Paul W

Packy, Theodore F

Buttar, Simran

Kelly, Lawrence William

Malik, Somair

Miller, Nicholas Wyatt

Cooling, David