NPIMap

Organization Active NPI

Stony Brook Emergency Physicians, University Faculty Practice Corporat

  • Emergency Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1265487672
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
STONY BROOK EMERGENCY PHYSICIANS, UNIVERSITY FACULTY PRACTICE CORPORAT
Practice address
Suny @ Stony Brook
University Hospital, L4, RM 515
Stony Brook, NY 11794-0001
Phone
(631) 444-2406
NPI assigned
May 24, 2006
Last updated
Oct 3, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Authorized official

Name
Dr. Mark Henry, M.D.NPI 1225066905
Title
Chair Person
Phone
(631) 444-2406

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
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

Suny @ Stony Brook
University Hospital, L4, RM 515
Stony Brook, NY 11794-0001

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-2406

Other identifiers 1

IdentifierTypeStateIssuer
01278739MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040320000283 NY Part B Supplier - Clinic/Group Practice 6507757648 Receives reassigned benefits from 95 practitioners
Practice locations: Stony Brook, NY; Riverhead, NY; Greenport, NY

National Provider Directory

National Provider Directory

Locations

100 Nicolls Rd
#7400L4
Stony Brook, NY 11794

Practitioners & affiliated clinicians

Practitioners 119

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 119

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": "1380758400000",
    "number": "1265487672",
    "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": "631-444-2406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "UNIVERSITY HOSPITAL, L4, RM 515",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-2406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK EMERGENCY PHYSICIANS, UNIVERSITY FACULTY PRACTICE CORPORAT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-2406",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01278739",
            "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 3, 2013; 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.