Healthcare Provider Details

I. General information

NPI: 1184679342
Provider Name (Legal Business Name): STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNY @ STONY BROOK HSC, L16, RM 020
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

PO BOX 1554
STONY BROOK NY
11790-0988
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2448
  • Fax:
Mailing address:
  • Phone: 631-444-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT YANG
Title or Position: CHAIR PERSON
Credential: MD, PHD
Phone: 631-444-2448