Provider Demographics
NPI:1841364288
Name:STONY BROOK PEDIATRICS, PC
Entity type:Organization
Organization Name:STONY BROOK PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-335-5200
Mailing Address - Street 1:22 RED JACKET STREET
Mailing Address - Street 2:PO BOX 499
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0491
Mailing Address - Country:US
Mailing Address - Phone:585-335-5200
Mailing Address - Fax:585-335-8579
Practice Address - Street 1:22 RED JACKET STREET
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-0491
Practice Address - Country:US
Practice Address - Phone:585-335-5200
Practice Address - Fax:585-335-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty