Healthcare Provider Details

I. General information

NPI: 1104774785
Provider Name (Legal Business Name): COURTNEY LIVINGSTON CHAMBERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-8434
US

IV. Provider business mailing address

101 NICOLLS RD HEALTH SCIENCES CENTER, LEVEL 4
STONY BROOK NY
11794-8434
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1916
  • Fax: 631-444-3765
Mailing address:
  • Phone: 631-444-1916
  • Fax: 631-444-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: