Basic Information
| Provider Information | |||||||||
| NPI: | 1487997821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | MINDY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HSC LEVEL 16, 020 | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, SUNY STONYBROOK | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117908160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314447411 | ||||||||
| FaxNumber: | 6314442493 | ||||||||
| Practice Location | |||||||||
| Address1: | HSC LEVEL 16, 020 | ||||||||
| Address2: | DEPARTMENT OF MEDICINE, SUNY STONYBROOK | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117908160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314447411 | ||||||||
| FaxNumber: | 6314442493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2013 | ||||||||
| LastUpdateDate: | 04/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.