1467411991 NPI number — UNIVERSITY HOSPITAL AT STONY BROOK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467411991 NPI number — UNIVERSITY HOSPITAL AT STONY BROOK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY HOSPITAL AT STONY BROOK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STONY BROOK EASTERN LONG ISLAND HOSPITAL PSYCH UNIT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467411991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MANOR PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11944-1222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-477-1000
Provider Business Mailing Address Fax Number:
631-477-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 MANOR PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11944-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-477-1000
Provider Business Practice Location Address Fax Number:
631-477-1746
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONNOR
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CAO
Authorized Official Telephone Number:
631-477-1000

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000538 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00274337 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com