Provider Demographics
NPI:1093467094
Name:GALOFARO, SEBASTIAN JR (NP)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:
Last Name:GALOFARO
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-0846
Mailing Address - Country:US
Mailing Address - Phone:631-260-6527
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS ROAD
Practice Address - Street 2:HSC T12-080 SUNY STONY BROOK/NEUROSURGERY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF348994-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily