Healthcare Provider Details

I. General information

NPI: 1952572307
Provider Name (Legal Business Name): KIMBERLY SUE TAFURI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NICOLLS RD STONY BROOK HOSPITAL DEPT OF PEDIATRICS HSC T11 ROOM080
STONY BROOK NY
11794-8111
US

IV. Provider business mailing address

100 NICOLLS RD STONY BROOK HOSPITAL DEPT OF PEDIATRICS HSC T11 ROOM080
STONY BROOK NY
11794-8111
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-3429
  • Fax: 631-444-6045
Mailing address:
  • Phone: 631-444-3429
  • Fax: 631-444-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number252022
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: