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General NPI Number Information
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NPI Number | 1215181680
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Entity Type | Organization
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Legal Business Name | STONY BROOK UNIVERSITY HOSPITAL
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | STONY BROOK HOSPITAL NICHOLLS RD CARDIOLOGY DEPARTMENT
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-1066
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Fax | 631-444-1054
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Provider Business Mailing Address
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Address Line | 574 MORICHES RD
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City | SAINT JAMES
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State | NY
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Zip | 11780-1367
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Country | US
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Telephone | 631-444-1066
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Fax | 631-444-1054
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Authorized Official
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Title or Position | NURSE PRACTITIONER/CARDIOLOGY
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Name | MS. KATHALEEN FRANCES DONNELLY
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Credential | NURSE PRACTITIONER
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Telephone | 631-444-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number |
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License Number State |
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