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General NPI Number Information
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NPI Number | 1235923269
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Entity Type | Organization
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Legal Business Name | STONY BROOK HOLISTIC WELLNESS, LLC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 26
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-364-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 26
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-364-9038
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DR. RAYMOND LOUIS
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Credential | PHD
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Telephone | 631-653-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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