Provider Demographics
NPI:1033475777
Name:STONYBROOK UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:STONYBROOK UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-444-1066
Mailing Address - Street 1:NICHOLLS RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-3301
Mailing Address - Fax:
Practice Address - Street 1:15 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3226
Practice Address - Country:US
Practice Address - Phone:631-979-5406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302633-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital