Provider Demographics
NPI:1942223672
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:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-444-4100
Mailing Address - Street 1:NICOLLS RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-9112
Mailing Address - Country:US
Mailing Address - Phone:631-444-4100
Mailing Address - Fax:631-444-4082
Practice Address - Street 1:NICOLLS RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-9112
Practice Address - Country:US
Practice Address - Phone:631-444-4100
Practice Address - Fax:631-444-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5151001H207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03002251Medicaid
NYUN0W761310Medicare ID - Type Unspecified