Healthcare Provider Details

I. General information

NPI: 1558470427
Provider Name (Legal Business Name): UNIVERSITY HOSPITAL AT STONY BROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 W MONTAUK HWY
HAMPTON BAYS NY
11946-2304
US

IV. Provider business mailing address

184 W MONTAUK HWY
HAMPTON BAYS NY
11946-2304
US

V. Phone/Fax

Practice location:
  • Phone: 631-723-4200
  • Fax:
Mailing address:
  • Phone: 631-723-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. CALOGERO GRESALFI
Title or Position: DIRECTOR
Credential:
Phone: 631-723-4213