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General NPI Number Information
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NPI Number | 1265487672
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Entity Type | Organization
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Legal Business Name | STONY BROOK EMERGENCY PHYSICIANS, UNIVERSITY FACULTY PRACTICE CORPORAT
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | SUNY @ STONY BROOK UNIVERSITY HOSPITAL, L4, RM 515
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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 | 631-444-2406
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1554
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City | STONY BROOK
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State | NY
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Zip | 11790-0988
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Country | US
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Telephone | 631-444-2406
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Fax |
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Authorized Official
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Title or Position | CHAIR PERSON
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Name | DR. MARK HENRY
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Credential | M.D.
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Telephone | 631-444-2406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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