Healthcare Provider Details

I. General information

NPI: 1316054588
Provider Name (Legal Business Name): AMY BETH GRUEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK ANESTHESIOLOGY UFPC HEALTH SCIENCE CENTER LEVEL 4 #060
STONY BROOK NY
11794-8480
US

IV. Provider business mailing address

STONY BROOK ANESTHESIOLOGY UFPC HEALTH SCIENCE CENTER LEVEL 4 #060
STONY BROOK NY
11794-8480
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2975
  • Fax: 631-444-2907
Mailing address:
  • Phone: 631-444-2975
  • Fax: 631-444-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS 9910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: