NPIMap

Organization Active NPI

Stony Brook Radiology, University Faculty Practice Corporation

  • Diagnostic Radiology Physician
  • Stony Brook, NY
National Provider Identifier
1366497448
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
STONY BROOK RADIOLOGY, UNIVERSITY FACULTY PRACTICE CORPORATION
Practice address
Suny at Stony BRK
HSC, L4, RM 120
Stony Brook, NY 11794-8460
Phone
(631) 444-3452
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Authorized official

Name
Dr. Elaine S Gould, M.D.NPI 1649207465
Title
Chair Person
Phone
(631) 444-3452

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X

Addresses

Primary practice location

Suny at Stony BRK
HSC, L4, RM 120
Stony Brook, NY 11794-8460

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-3452

Other identifiers 1

IdentifierTypeStateIssuer
00549133MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001029 NY Part B Supplier - Clinic/Group Practice 4587555198 Receives reassigned benefits from 68 practitioners
Practice locations: Stony Brook, NY; Southampton, NY; Riverhead, NY; Manorville, NY; Port Jefferson, NY; Centereach, NY; Commack, NY; Greenport, NY…

National Provider Directory

National Provider Directory

Locations

500 Commack Rd
Ste 101
Commack, NY 11725
Phone (631) 638-2600

500 Commack Rd
Fl 1
Commack, NY 11725

179 N Belle Mead Rd
East Setauket, NY 11733
Phone (631) 444-1970

37 Research Way
#C
East Setauket, NY 11733
Phone (631) 444-4550

4 Smith Haven Mall
Ste 104
Lake Grove, NY 11755

350 Old Country Rd
Riverhead, NY 11901

Lauterbur Dr Level 5
Rm 5
Stony Brook, NY 11794

3 Edmund D Pellegrino Rd
Stony Brook, NY 11794
Phone (631) 638-0800

Sbumc Level 4
Stony Brook, NY 11794

Lauterbur Dr
Rm 5M0203
Stony Brook, NY 11794

Univ Hspl2 Mod O
Stony Brook, NY 11794

Univ Hspl4
Stony Brook, NY 11794

101 Nicolls Rd
#O
Stony Brook, NY 11794

100 Nicolls Rd
Rm 120
Stony Brook, NY 11794
Phone (631) 444-2480

100 Nicholls Rd Lvl 4
Rm 120
Stony Brook, NY 11794

Stony Brk Univ Level4 Radiolog
Stony Brook, NY 11794

Univ Hspl4
Dept Of Radiology
Stony Brook, NY 11794

University Hospital Level 4
Stony Brook, NY 11794

Hsc Level 4
Rm 120
Stony Brook, NY 11794
Phone (631) 444-7955

Suny At Stony Brk
Stony Brook, NY 11794
Phone (631) 444-2492

100 Nicolls Rd
Rm 1
Stony Brook, NY 11794

100 Nicolls Rd
Stony Brook, NY 11790
Phone (631) 444-1069

Practitioners & affiliated clinicians

Practitioners 85

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 85

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": "1688601600000",
    "number": "1366497448",
    "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": "631-444-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY AT STONY BRK",
            "address_2": "HSC, L4, RM 120",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948460",
            "telephone_number": "631-444-3452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK RADIOLOGY, UNIVERSITY FACULTY PRACTICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-3452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00549133",
            "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 Jul 6, 2023; 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.