1134578750 NPI number — MRS. CAITLIN MARIE BORRIELLO N.P

Table of content: MRS. CAITLIN MARIE BORRIELLO N.P (NPI 1134578750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134578750 NPI number — MRS. CAITLIN MARIE BORRIELLO N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORRIELLO
Provider First Name:
CAITLIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONAHUE
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134578750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Second Line Business Mailing Address:
HEALTH SCIENCES CENTER LEVEL 16 ROOM 080
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-1060
Provider Business Mailing Address Fax Number:
631-444-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MOTOR PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-9600
Provider Business Practice Location Address Fax Number:
631-444-9621
Provider Enumeration Date:
06/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  30-307387 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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