1982399952 NPI number — DR. TIMOTHY RYAN CASA-MALONE MD, MPH

Table of content: DR. TIMOTHY RYAN CASA-MALONE MD, MPH (NPI 1982399952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982399952 NPI number — DR. TIMOTHY RYAN CASA-MALONE MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASA-MALONE
Provider First Name:
TIMOTHY
Provider Middle Name:
RYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1982399952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HEALTH SCIENCES CENTER T19-030 STONY BROOK MEDICINE
Provider Second Line Business Mailing Address:
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:
631-444-1791
Provider Business Mailing Address Fax Number:
631-444-7689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 MONTGOMERY AVE
Provider Second Line Business Practice Location Address:
DEPT OF ANESTHESIOLOGY
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-8004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-894-5939
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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