Provider Demographics
NPI:1538114723
Name:UNIVERSITY ASSOCIATES IN OBSTETRICS & GYNECOLOGY, UNIVERSITY FACULTY P
Entity Type:Organization
Organization Name:UNIVERSITY ASSOCIATES IN OBSTETRICS & GYNECOLOGY, UNIVERSITY FACULTY P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR PERSON
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-444-2731
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-2731
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:SUNY @ STONY BROOK HSC, L9, RM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8091
Practice Address - Country:US
Practice Address - Phone:631-444-2731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02226511Medicaid
NY02226511Medicaid