Healthcare Provider Details

I. General information

NPI: 1457340556
Provider Name (Legal Business Name): DR. RUSSELL DAVID AREMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK HOSPITAL 100 NICOLLS RD HSC
STONY BROOK NY
11794-8460
US

IV. Provider business mailing address

STONY BROOK HOSPITAL 100 NICOLLS RD HSC
STONY BROOK NY
11794-8460
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5400
  • Fax:
Mailing address:
  • Phone: 631-444-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2302951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: