NPIMap

Organization Active NPI

Stony Brook Internists, University Faculty Practice Corporation

  • Gastroenterology Physician
  • Stony Brook, NY
National Provider Identifier
1265471809
Registry record updated Feb 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Practice address
Suny @ Stony Brook
HSC, L16, RM 020
Stony Brook, NY 11794-0001
Phone
(631) 444-2448
NPI assigned
Jun 6, 2006
Last updated
Feb 6, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2015

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

Authorized official

Name
Vincent Yang, M.D.
Title
President
Phone
(631) 444-2448

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X NU Primary

Addresses

Primary practice location

Suny @ Stony Brook
HSC, L16, RM 020
Stony Brook, NY 11794-0001

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-2448

Other identifiers 2

IdentifierTypeStateIssuer
00615265MedicaidNY
CB8937OtherNYRAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040524000844 NY Part B Supplier - Clinic/Group Practice 9133019821 Receives reassigned benefits from 48 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Babylon, NY; Commack, NY; East Setauket, NY; Hauppauge, NY; Port Jefferson Station, NY; Southampton, NY; Stony Brook, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Haldun C Mutlu

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1265471809",
    "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": "631-444-2448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "HSC, L16, RM 020",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-2448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION",
        "enumeration_date": "2006-06-06",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-444-2448",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00615265",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CB8937",
            "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 Feb 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.