Provider Demographics
NPI:1356498166
Name:BIANCHI-HAYES, JOSETTE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JOSETTE
Middle Name:MARIE
Last Name:BIANCHI-HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOSETTE
Other - Middle Name:MARIE
Other - Last Name:BIANCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:STONY BROOK CHILDRENS HOSPITAL
Mailing Address - Street 2:HSC 11TH FLOOR ROOM 060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-1152
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK CHILDRENS HOSPITAL
Practice Address - Street 2:HSC 11TH FLOOR ROOM 060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264416-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513135Medicaid
TN3041698Medicare PIN