Healthcare Provider Details

I. General information

NPI: 1790027415
Provider Name (Legal Business Name): SETH KORBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF ORTHOPAEDICS HSC T 18 STONY BROOK UNIVERSITY MEDICAL CTR
STONY BROOK NY
11794-8181
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1487
  • Fax: 631-444-3502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number278367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: