Healthcare Provider Details

I. General information

NPI: 1104742071
Provider Name (Legal Business Name): MEDICAL SERVICES OF STONY BROOK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 MONTAUK HWY
WEST ISLIP NY
11795-4411
US

IV. Provider business mailing address

722 MONTAUK HWY
WEST ISLIP NY
11795-4411
US

V. Phone/Fax

Practice location:
  • Phone: 833-666-6066
  • Fax: 631-337-7698
Mailing address:
  • Phone: 833-666-6066
  • Fax: 631-337-7698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLENE BRONSTORPH
Title or Position: DIRECTOR
Credential:
Phone: 516-850-3999