Healthcare Provider Details

I. General information

NPI: 1861925299
Provider Name (Legal Business Name): DAVID NICHOLAS HURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF MEDICINE HSC LEVEL 16 SUNY STONY BROOK HOSPITAL
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2058
  • Fax: 631-444-2493
Mailing address:
  • Phone: 631-444-2058
  • Fax: 631-444-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number307062-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: