Healthcare Provider Details

I. General information

NPI: 1447517842
Provider Name (Legal Business Name): EDWARD J PAPA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS ROAD STONY BROOK ANESTHESIOLOGY
STONY BROOK NY
11794-8480
US

IV. Provider business mailing address

101 NICOLLS ROAD STONY BROOK ANESTHESIOLOGY PO BOX 1559
STONY BROOK NY
11794-8480
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2975
  • Fax: 631-444-2907
Mailing address:
  • Phone: 631-988-9289
  • Fax: 631-444-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number273202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: