Healthcare Provider Details

I. General information

NPI: 1225023963
Provider Name (Legal Business Name): UNIVERSITY HOSPITAL STONY BROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY MEDICAL CENTER DIVISION OF CARDIOTHORACIC SURGERY T19,HSC, ROOM 080
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

43 SHORE RD
EAST SETAUKET NY
11733-3920
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1820
  • Fax: 631-444-8963
Mailing address:
  • Phone: 631-751-2106
  • Fax: 631-751-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberF300862
License Number StateNY

VIII. Authorized Official

Name: MRS. BARBARA MCCABE MILLS
Title or Position: SENIOR NURSE PRACTITIONER
Credential: NP
Phone: 631-444-1820