Provider Demographics
NPI:1376573949
Name:EGNOR, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:EGNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HSC T12 RM 080
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:631-444-1213
Mailing Address - Fax:631-444-1535
Practice Address - Street 1:24 RESEARCH WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3487
Practice Address - Country:US
Practice Address - Phone:631-444-1213
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185484207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4398846OtherAETNA
NY89F84OtherEMPIRE BC.BS
NY01247456Medicaid
NY4398846OtherAETNA
NY89F841Medicare ID - Type Unspecified