Provider Demographics
NPI:1932466604
Name:UNIVERSITY HOSPITAL AT STONY BROOK
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL AT STONY BROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO - STONY BROOK SOUTHAMPTON HOSP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-726-8300
Mailing Address - Street 1:300 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1264
Mailing Address - Country:US
Mailing Address - Phone:631-477-1871
Mailing Address - Fax:631-477-0219
Practice Address - Street 1:300 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1264
Practice Address - Country:US
Practice Address - Phone:631-477-1871
Practice Address - Fax:631-477-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5126000H261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center