NPIMap

Organization Active NPI

State of New York Comptrollers Office

Doing business as SUNY Stony Brook School of Dental Medicine

  • Dentist
  • Stony Brook, NY
National Provider Identifier
1053482067
Registry record updated Aug 3, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
377821 Issued in NY
Legal business name
STATE OF NEW YORK COMPTROLLERS OFFICE
Doing business as
SUNY Stony Brook School of Dental Medicine
Practice address
184D Nichols Road Sullivan Hall
Stony Brook, NY 11794
Phone
(631) 632-8966
Fax
(631) 632-9302
NPI assigned
Nov 13, 2006
Last updated
Aug 3, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF NEW YORK COMPTROLLERS OFFICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carol Sloane
Title
Asst. Dean Clinic Operations
Phone
(631) 632-8966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 377821 NY Primary

Addresses

Primary practice location

184D Nichols Road Sullivan Hall
Stony Brook, NY 11794

Mailing address

184D Nichols Road Sullivan Hall
Stony Brook, NY 11794-0001
Phone (631) 632-8966

Other identifiers 1

IdentifierTypeStateIssuer
00475076MedicaidNY

Other names 1

  • SUNY Stony Brook School of Dental Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170926003852 NY Part B Supplier - Clinic/Group Practice 0840101770 Receives reassigned benefits from 2 practitioners
Practice locations: Stony Brook, NY

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Wilton Devel Ctr Rev M269 organizations share this tax ID, including this one
Part of
Wilton Devel Ctr Rev M

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1 Nicolls Rd
#184
Stony Brook, NY 11794
Phone (631) 632-8966

184D Nichols Rd Sullivan Hall
Stony Brook, NY 11794
Phone (631) 632-8966

Ownership & related parties

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Helen Hayes HospitalWest Haverstraw, NY, CCN 330405 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Suny Health Science Center at SyracuseSyracuse, NY, CCN 33S241 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Suny Health Science Center at SyracuseSyracuse, NY, CCN 33T241 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Helen Hayes HospitalWest Haverstraw, NY, CCN 33T405 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
University Hospital of Brooklyn Suny Downstate Health Sciences UniversBrooklyn, NY, CCN 330350 Hospital 5% Or Greater Indirect Ownership Interest Dec 22, 1966
University Hospital of Brooklyn Suny Downstate Health Sciences UniversBrooklyn, NY, CCN 33T350 Hospital 5% Or Greater Indirect Ownership Interest Dec 22, 1966
Nys Veterans Home at MontroseMontrose, NY, CCN 335832 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 11, 2001
Long Island State Veterans HomeStony Brook, NY, CCN 335758 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF
Direct Ownership Interest (100%)		 Oct 23, 1991
Oct 23, 1991
Oct 23, 1991
New York Veterans Home at BataviaBatavia, NY, CCN 335788 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Apr 1, 1995
Apr 1, 1995
Apr 1, 1995
New York State Veterans HomeOxford, NY, CCN 335097 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Apr 1, 1971
Apr 1, 1971
Apr 1, 1971
Nys Veterans Home at St. AlbansJamaica, NY, CCN 335770 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 31, 1993
Sep 24, 2009
Helen Hayes HospitalWest Haverstraw, NY, CCN 335873 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Apr 14, 2016
Aug 10, 2016
Aug 10, 2016
Helen Hayes Hospital RHCFWest Haverstraw, NY, CCN 335823 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533254400000",
    "number": "1053482067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184D NICHOLS ROAD SULLIVAN HALL",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-632-8966",
            "fax_number": "631-632-9302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184D NICHOLS ROAD SULLIVAN HALL",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11794",
            "telephone_number": "631-632-8966",
            "fax_number": "631-632-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW YORK COMPTROLLERS OFFICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW YORK COMPTROLLERS OFFICE",
        "enumeration_date": "2006-11-13",
        "last_updated": "2018-08-03",
        "status": "A",
        "authorized_official_last_name": "SLOANE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "ASST. DEAN CLINIC OPERATIONS",
        "authorized_official_telephone_number": "631-632-8966"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "377821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00475076",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUNY Stony Brook School of Dental Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.