Basic Information
| Provider Information | |||||||||
| NPI: | 1215181680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONY BROOK UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 574 MORICHES RD | ||||||||
| Address2: | |||||||||
| City: | SAINT JAMES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117801367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441066 | ||||||||
| FaxNumber: | 6314441054 | ||||||||
| Practice Location | |||||||||
| Address1: | STONY BROOK HOSPITAL NICHOLLS RD | ||||||||
| Address2: | CARDIOLOGY DEPARTMENT | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314441066 | ||||||||
| FaxNumber: | 6314441054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2008 | ||||||||
| LastUpdateDate: | 11/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | DONNELLY | ||||||||
| AuthorizedOfficialFirstName: | KATHALEEN | ||||||||
| AuthorizedOfficialMiddleName: | FRANCES | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER/CARDIOLOGY | ||||||||
| AuthorizedOfficialTelephone: | 6314441066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRACTITIONER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.