Healthcare Provider Details

I. General information

NPI: 1699720888
Provider Name (Legal Business Name): NEUROLOGY ASSOCIATES OF STONY BROOK, UNIVERSITY FACULTY PRACTICE CORPO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD RM 20
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

PO BOX 1554
STONY BROOK NY
11790-0988
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2599
  • Fax: 631-441-4744
Mailing address:
  • Phone: 631-444-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC W HALTERMAN
Title or Position: PRESIDENT / DIRECTOR
Credential: M.D., PHD
Phone: 631-444-2599