Healthcare Provider Details

I. General information

NPI: 1942417399
Provider Name (Legal Business Name): STONY BROOK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

T 19 HSC RM 080
STONY BROOK NY
11794-8191
US

IV. Provider business mailing address

677 ORIOLE AVE
WEST HEMPSTEAD NY
11552-3828
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1820
  • Fax:
Mailing address:
  • Phone: 516-485-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberF3011419
License Number StateMS

VIII. Authorized Official

Name: MRS. CHRISTANA CAINES
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 631-444-1820