Provider Demographics
NPI:1700026077
Name:STONY BROOK HOSPITAL
Entity Type:Organization
Organization Name:STONY BROOK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-444-1066
Mailing Address - Street 1:574 MORICHES RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1367
Mailing Address - Country:US
Mailing Address - Phone:516-607-9111
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK HOSPITAL MEDICAL
Practice Address - Street 2:NICHOLLS ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302481-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY302481-1OtherNURSE PRACTITIONER LICENSE NUMBER