Healthcare Provider Details

I. General information

NPI: 1861897621
Provider Name (Legal Business Name): JULIE VINOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE ALEX

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK HOSPITAL 100 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

2 GLATTER LN
SOUTH SETAUKET NY
11720-1032
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1066
  • Fax:
Mailing address:
  • Phone: 631-487-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305509-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: