Provider Demographics
NPI:1235389990
Name:STABLES-CARNEY, TERESA (RNC, PNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:STABLES-CARNEY
Suffix:
Gender:F
Credentials:RNC, PNP
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 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-8340
Mailing Address - Fax:631-444-6045
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CTR
Practice Address - Street 2:HSC-T-11-080, DEPT. PEDIATRICS
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-8340
Practice Address - Fax:631-444-6045
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380427363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03764087Medicaid