Provider First Line Business Practice Location Address: 
STONY BROOK DERMATOLOGY ASSOCIATES
    Provider Second Line Business Practice Location Address: 
1320 STONY BROOK ROAD BUILDING F, SUITE 200
    Provider Business Practice Location Address City Name: 
STONY BROOK
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11790
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
631-444-4200
    Provider Business Practice Location Address Fax Number: 
631-444-4276
    Provider Enumeration Date: 
11/14/2014