Provider Demographics
NPI:1578502100
Name:STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Entity Type:Organization
Organization Name:STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR PERSON
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:631-444-2448
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:631-444-2448
Mailing Address - Fax:
Practice Address - Street 1:SUNY @ STONY BROOK
Practice Address - Street 2:HSC, L16, RM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCB8937OtherRAILROAD
NY00615265Medicaid
NYCB8937OtherRAILROAD