MEDICARE: UNIVERSITY HOSPITAL AT STONY BROOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1225507114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITAL AT STONY BROOK

Provider Business Mailing Address
First Line	:	100 NICOLLS ROAD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8410
Country	:	US
Telephone Number	:	631-444-7581
Fax Number	:	631-444-7431

Provider Business Practice Location Address
First Line	:	740 COUNTY ROAD 39
Second Line	:
City	:	SOUTHAMPTON
State	:	NY
Zip	:	11968-5090
Country	:	US
Telephone Number	:	631-444-4100
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. GARY E. BIE
Credential	:	CPA
Telephone Number	:	631-444-7581

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	11/20/2018

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