Provider Demographics
NPI:1538301999
Name:UNIVERSITY HOSPITAL AT STONY BROOK
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL AT STONY BROOK
Other - Org Name:STONY BROOK UNIVERSITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:JEANNENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRIANSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-444-2674
Mailing Address - Street 1:NICOLLS RD
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-2680
Mailing Address - Fax:631-444-7935
Practice Address - Street 1:NICOLLS RD
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2680
Practice Address - Fax:631-444-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0164023336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3360649OtherNCPDP PROVIDER IDENTIFICATION NUMBER