Healthcare Provider Details

I. General information

NPI: 1386775385
Provider Name (Legal Business Name): STONYBROOK SURIGCAL ASSOICATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 PELLERGRINO ROAD
STONYBROOK NY
11790-9444
US

IV. Provider business mailing address

37 RESEARCHWAY 8 EDMOUND PELLERGRINO ROAD
STONY BROOK NY
11790-9444
US

V. Phone/Fax

Practice location:
  • Phone: 631-638-0928
  • Fax: 631-638-0644
Mailing address:
  • Phone: 631-638-0928
  • Fax: 631-638-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. MARTIN KARPETH
Title or Position: CEO
Credential: MD
Phone: 631-444-4545