Mary Immaculate Hospital

Primary specialty

Critical Access HospitalTaxonomy code 282NC0060X

License

115646 Issued in NY

Legal business name

MARY IMMACULATE HOSPITAL

Practice address

24 Night Heron Dr
Stony Brook, NY 11790-1108

Phone

(631) 689-5654

Fax

(718) 558-2166

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Usha C Ruder, M.D.

Title

Chair, Pathology Department

Phone

(715) 558-2714

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245364223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152-11 89TH AVE.",
            "address_2": "MARY IMMACULATE HOSPITAL ,",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321108",
            "telephone_number": "718-558-2714",
            "fax_number": "718-558-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 NIGHT HERON DR",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901108",
            "telephone_number": "631-689-5654",
            "fax_number": "718-558-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY IMMACULATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUDER",
        "authorized_official_first_name": "USHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHAIR, PATHOLOGY DEPARTMENT",
        "authorized_official_telephone_number": "715-558-2714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NY",
            "license": "115646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keri Martinez, NURSE PRACTITIONER
• Nuria Marlene Martinez, CNM
• Magdalena Martini, PA-C, PHD
• Jennifer M Martino-Hahn, MD
• Nicole Marie Martino, R.N.
• Lauren Marzolini
• Matthew Gerard Masiello, PA-C
• Maryanna Mason, M.D.
• Zaki Masoud, MD
• Marisa Massaro, NP

• Critical Access Hospital in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Critical Access Hospital in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.