Provider Demographics
NPI:1942417399
Name:STONY BROOK MEDICAL CENTER
Entity Type:Organization
Organization Name:STONY BROOK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAINES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:631-444-1820
Mailing Address - Street 1:677 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3828
Mailing Address - Country:US
Mailing Address - Phone:516-485-9887
Mailing Address - Fax:
Practice Address - Street 1:T 19 HSC RM 080
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8191
Practice Address - Country:US
Practice Address - Phone:631-444-1820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF3011419282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access