Healthcare Provider Details

I. General information

NPI: 1780829226
Provider Name (Legal Business Name): STONY BROOK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONYBROOK MEDICAL CTR
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

STONY BROOK MEDICAL CTR
STONY BROOK NY
11794-0001
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ANNA KOGAN
Title or Position: ANESTHESIA RESIDENT
Credential: DO
Phone: 631-444-2578