Healthcare Provider Details

I. General information

NPI: 1700026077
Provider Name (Legal Business Name): STONY BROOK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK HOSPITAL MEDICAL NICHOLLS ROAD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

574 MORICHES RD
SAINT JAMES NY
11780-1367
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1066
  • Fax:
Mailing address:
  • Phone: 516-607-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number302481-1
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM LAWSON
Title or Position: ATTENDING
Credential: M.D.
Phone: 631-444-1066