Provider Demographics
NPI:1487850251
Name:STONY BROOK UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:STONY BROOK UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:CAREN
Authorized Official - Last Name:BERGSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-699-3460
Mailing Address - Street 1:2428 AVALON PINES DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-5169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2428 AVALON PINES DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-5169
Practice Address - Country:US
Practice Address - Phone:917-699-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty