Healthcare Provider Details

I. General information

NPI: 1962515825
Provider Name (Legal Business Name): CARL PHILIP KAPLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF PEDIATRICS STONY BROOK UNIVERSITY HSC T-11, ROOM 020
STONY BROOK NY
11794-8111
US

IV. Provider business mailing address

PO BOX 1559
STONY BROOK NY
11790-0989
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8014
  • Fax: 631-444-7865
Mailing address:
  • Phone: 631-444-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number227696
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number227696
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: