Healthcare Provider Details

I. General information

NPI: 1700849338
Provider Name (Legal Business Name): EUGENE T. KING R.P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW YORK SPINE AND BRAIN SURGERY HSC T12 RM 080
STONY BROOK NY
11794-8122
US

IV. Provider business mailing address

NEW YORK SPINE AND BRAIN SURGERY HSC T12 RM 080
STONY BROOK NY
11794-8122
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1213
  • Fax: 631-444-1535
Mailing address:
  • Phone: 631-444-1116
  • Fax: 631-444-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001662
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: