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General NPI Number Information
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NPI Number | 1497700819
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Entity Type | Organization
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Legal Business Name | STONY BROOK DERMATOLOGY ASSOCIATES, UNIVERSITY FACULTY PRACTICE CORPOR
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | SUNY @ STONY BROOK HSC, L16, RM 060
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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 | 631-444-7597
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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 | 631-444-7597
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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. EVAN JONES
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Credential | M.D.
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Telephone | 631-444-7597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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