Provider Demographics
NPI:1275338105
Name:UNIVERSITY HOSPITAL AT STONY BROOK
Entity type:Organization
Organization Name:UNIVERSITY HOSPITAL AT STONY BROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FOR HEALTH SYSTEM FINANCE AND BU
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:631-444-7581
Mailing Address - Street 1:100 NICOLLS ROAD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8410
Mailing Address - Country:US
Mailing Address - Phone:631-444-4100
Mailing Address - Fax:631-444-4082
Practice Address - Street 1:500 COMMACK ROAD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5020
Practice Address - Country:US
Practice Address - Phone:631-444-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY HOSPITAL AT STONY BROOK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03002260Medicaid