Provider Demographics
NPI:1215181680
Name:STONY BROOK UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:STONY BROOK UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/CARDIOLOGY
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHALEEN
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:631-444-1066
Mailing Address - Street 1:574 MORICHES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1367
Mailing Address - Country:US
Mailing Address - Phone:631-444-1066
Mailing Address - Fax:631-444-1054
Practice Address - Street 1:STONY BROOK HOSPITAL NICHOLLS RD
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1066
Practice Address - Fax:631-444-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access