MEDICARE: STONYBROOK MEDICAL CENTER, INC.

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	207R00000X	Internal Medicine Physician	MD034446E	PA

General Provider Information

NPI Number	:	1861565509
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONYBROOK MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	50 SERPENTINE LN
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19055-2213
Country	:	US
Telephone Number	:	215-946-4410
Fax Number	:	215-946-5846

Provider Business Practice Location Address
First Line	:	50 SERPENTINE LN
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19055-2213
Country	:	US
Telephone Number	:	215-946-4410
Fax Number	:	215-946-5846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LUIGI DE SANTIS
Credential	:	MD
Telephone Number	:	215-946-4410

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	04/28/2008

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