Provider Demographics
NPI:1023556024
Name:STONYBROOK UNIVERSITY STUDENT HEALTH SERVICE
Entity Type:Organization
Organization Name:STONYBROOK UNIVERSITY STUDENT HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-632-6740
Mailing Address - Street 1:1 STADIUM RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-3191
Mailing Address - Country:US
Mailing Address - Phone:631-632-6740
Mailing Address - Fax:631-632-6936
Practice Address - Street 1:1 STADIUM RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3191
Practice Address - Country:US
Practice Address - Phone:631-632-6740
Practice Address - Fax:631-632-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health