=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275338105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY HOSPITAL AT STONY BROOK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2025
-----------------------------------------------------
Last Update Date | 02/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 COMMACK ROAD
-----------------------------------------------------
City | COMMACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11725-5020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-444-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 NICOLLS ROAD
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11794-8410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-444-4100
-----------------------------------------------------
Fax | 631-444-4082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FOR HEALTH SYSTEM FINANCE AND BU
-----------------------------------------------------
Name | MR. GARY E. BIE
-----------------------------------------------------
Credential | CPA
-----------------------------------------------------
Telephone | 631-444-7581
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------