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General NPI Number Information
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NPI Number | 1023201415
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Entity Type | Organization
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Legal Business Name | SUNY STONY BROOK
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | HSC LEVEL 12 ROOM 080
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City | STONY BROOK
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State | NY
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Zip | 11794-8122
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Country | US
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Telephone | 631-444-1289
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Fax |
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Provider Business Mailing Address
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Address Line | HSC LEVEL 12 ROOM 080
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City | STONY BROOK
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State | NY
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Zip | 11794-8122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | DIANE CARLSON
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Credential |
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Telephone | 631-444-8073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 430131
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License Number State | NY
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