Healthcare Provider Details

I. General information

NPI: 1902082209
Provider Name (Legal Business Name): YUEHJIEN R GU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YUEJIE GU M.D

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF NEUROLOGICAL SURGERY NEW YORK SPINE AND BRAIN SURGERY HSC T12 RM 080
STONY BROOK NY
11794
US

IV. Provider business mailing address

DEPARTMENT OF NEUROLOGICAL SURGERY NEW YORK SPINE AND BRAIN SURGERY HSC T12 RM 080
STONY BROOK NY
11794-8122
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1116
  • Fax: 631-444-1535
Mailing address:
  • Phone: 631-444-3689
  • Fax: 631-444-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number266560
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number266560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: