NPIMap

Individual provider Active NPI

Farrukh Mansoor Koraishy, MD, PHD

  • Nephrology Physician
  • Stony Brook, NY
National Provider Identifier
1336108760
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
300229 Issued in NY
Practice address
101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone
(631) 444-1617
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301079643 MI
Nephrology Physician 207RN0300X 300229 NY Primary

Addresses

Primary practice location

101 Nicolls Rd
Stony Brook, NY 11794-0001

Mailing address

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (313) 522-9036

Other practice location 1

79 Middleville Rd
Northport, NY 11768-2296
Phone (631) 261-4400

Other identifiers 1

IdentifierTypeStateIssuer
110F376980OtherMIBCBSM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190913002663 NY Practitioner - Nephrology 2860411766 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

100 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1560

101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone (631) 444-1560

26 Research Way
East Setauket, NY 11733-3526
Phone (631) 444-0580

Lauterbur Dr
Stony Brook, NY 11794-0001
Phone (632) 638-1000

PO Box
Suite 1554
Stony Brook, NY 11790-0989

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospital at Stony Brook Current Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Internal Medicine Current Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Nephrology CurrentSince Oct 1, 2019 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation CurrentSince Oct 1, 2019 Accepting new patients
Stony Brook Internists, University Faculty Practice Corporation Past Accepting new patients

Locations

26 Research Way
East Setauket, NY 11733
Phone (631) 444-0502

101 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-2065

100 Nicolls Rd
#13202
Stony Brook, NY 11794

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: farrukh.koraishy@direct.stonybrookmedicine.edu

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1336108760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "313-522-9036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-1617"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 Middleville Rd",
            "address_purpose": "LOCATION",
            "city": "Northport",
            "state": "NY",
            "postal_code": "117682296",
            "country_code": "US",
            "telephone_number": "631-261-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORAISHY",
        "first_name": "FARRUKH",
        "middle_name": "MANSOOR",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301079643",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "300229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "110F376980",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.