Provider Demographics
NPI:1033224704
Name:UNIVERSITY HOSPITAL AT STONY BROOK
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL AT STONY BROOK
Other - Org Name:STONY BROOK SOUTHAMPTON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-726-8300
Mailing Address - Street 1:240 MEETING HOUSE LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968
Mailing Address - Country:US
Mailing Address - Phone:631-726-8200
Mailing Address - Fax:631-726-8886
Practice Address - Street 1:240 MEETING HOUSE LANE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968
Practice Address - Country:US
Practice Address - Phone:631-726-8200
Practice Address - Fax:631-726-8886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY HOSPITAL AT STONY BROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5126000H282N00000X
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
C011OtherVYTRA
NY00274406Medicaid
HO4447OtherOXFORD
000105OtherBLUE CROSS
AZ00007OtherMDNY
330340Medicare Oscar/Certification