Provider Demographics
NPI:1730384215
Name:BOLOGNESE, STEPHANIE (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BOLOGNESE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2323
Mailing Address - Country:US
Mailing Address - Phone:631-689-0234
Mailing Address - Fax:631-675-0262
Practice Address - Street 1:1 HOPEWELL DR
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2323
Practice Address - Country:US
Practice Address - Phone:631-689-0234
Practice Address - Fax:631-675-0262
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY542792-1163W00000X, 163WS0200X, 163WG0000X, 163WH0200X, 163WH1000X, 163WP0200X, 163WR0400X, 163WA0400X, 163WC0400X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01681263OtherMEDICAID PRIVATE PROVIDER