Basic Information
| Provider Information | |||||||||
| NPI: | 1548517410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONY BROOK UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 HARGROVE DR | ||||||||
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| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117902305 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 NICOLLS RD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314444000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2012 | ||||||||
| LastUpdateDate: | 08/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | MC GOVERN | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHAIR OF PEDIATRICS | ||||||||
| AuthorizedOfficialTelephone: | 6314444000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.