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General NPI Number Information
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NPI Number | 1649098203
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Entity Type | Organization
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Legal Business Name | TRUE NORTH MEDICAL OF STONY BROOK, P.C.
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 2119 MERRICK RD
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City | MERRICK
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State | NY
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Zip | 11566-4704
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Country | US
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Telephone | 516-377-2820
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Fax | 516-378-2968
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Provider Business Mailing Address
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Address Line | 522 3RD ST
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City | BROOKLYN
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State | NY
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Zip | 11215-3003
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Country | US
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Telephone | 718-768-8500
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Fax | 833-984-3445
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Authorized Official
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Title or Position | EVP & CFO
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Name | MICHELE L CUSACK
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Credential |
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Telephone | 516-321-6058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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