NPIMap

Organization Active NPI

New York Spine & Brain Surgery, University Faculty Practice Corporatio

  • Neurological Surgery Physician
  • Stony Brook, NY
National Provider Identifier
1154376309
Registry record updated Oct 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
NEW YORK SPINE & BRAIN SURGERY, UNIVERSITY FACULTY PRACTICE CORPORATIO
Practice address
Suny @ Stony Brook
HSC, L12, RM 080
Stony Brook, NY 11794-0001
Phone
(631) 444-1116
NPI assigned
May 24, 2006
Last updated
Oct 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2015

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

Authorized official

Name
Raphael P. Davis, M.D.NPI 1386674810
Title
Chair Person
Phone
(631) 444-1116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X Primary

Addresses

Primary practice location

Suny @ Stony Brook
HSC, L12, RM 080
Stony Brook, NY 11794-0001

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-1116

Other identifiers 1

IdentifierTypeStateIssuer
00778285MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315001414 NY Part B Supplier - Clinic/Group Practice 7719876796 Receives reassigned benefits from 68 practitioners
Practice locations: Riverhead, NY; Stony Brook, NY; Southampton, NY; Lake Grove, NY; Centereach, NY; Commack, NY; Greenport, NY

National Provider Directory

National Provider Directory

Locations

24 Research Way
Ste 200
East Setauket, NY 11733
Phone (631) 444-1210

31 Main Rd
Ste 3
Riverhead, NY 11901
Phone (631) 727-6308

1 Lauterbur Dr
Stony Brook, NY 11794
Phone (408) 828-3211

100 Nicolls Rd
#4
Stony Brook, NY 11790
Phone (631) 638-4170

100 Nicolls Rd
#L4
Stony Brook, NY 11794
Phone (631) 444-2976

100 Nicolls Rd
#T12080
Stony Brook, NY 11790

100 Nicolls Rd
Rm 80T12
Stony Brook, NY 11794

100 Nicolls Rd
Ste 340
Stony Brook, NY 11794

100 Nicolls Rd
Ste 430
Stony Brook, NY 11794

24 Research Way
Ste 200
Stony Brook, NY 11794

2500 Nesconset Hwy
#63
Stony Brook, NY 11790
Phone (631) 444-1210

Hsc T12
Rm 080
Stony Brook, NY 11794
Phone (631) 444-8070

Hsct12080
Stony Brook, NY 11794

Univ Hspl4
Ste 430
Stony Brook, NY 11794

Practitioners & affiliated clinicians

Practitioners 80

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.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444089600000",
    "number": "1154376309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1554",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117900988",
            "telephone_number": "631-444-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "HSC, L12, RM 080",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK SPINE & BRAIN SURGERY, UNIVERSITY FACULTY PRACTICE CORPORATIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2015-10-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-1116",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00778285",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.