Provider Demographics
NPI:1558470427
Name:UNIVERSITY HOSPITAL AT STONY BROOK
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL AT STONY BROOK
Other - Org Name:STONY BROOK SOUTHAMPTON HOSPITAL REGIONAL DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALOGERO
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESALFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-723-4213
Mailing Address - Street 1:184 W MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2304
Mailing Address - Country:US
Mailing Address - Phone:631-723-4200
Mailing Address - Fax:
Practice Address - Street 1:184 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2304
Practice Address - Country:US
Practice Address - Phone:631-723-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY HOSPITAL AT STONY BROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333533Medicare Oscar/Certification