NPIMap

Organization Active NPI

Stony Brook University Medical Center

  • Student in an Organized Health Care Education/Training Program
  • Coram, NY
National Provider Identifier
1487850251
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Legal business name
STONY BROOK UNIVERSITY MEDICAL CENTER
Practice address
2428 Avalon Pines Dr
Coram, NY 11727-5169
Phone
(917) 699-3460
NPI assigned
Jun 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jill Caren Bergson, MD
Title
Resident Physician
Phone
(917) 699-3460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training ProgramGroup: 193200000X MULTI-SPECIALTY GROUP 390200000X Primary

Addresses

Primary practice location

2428 Avalon Pines Dr
Coram, NY 11727-5169

Mailing address

2428 Avalon Pines Dr
Coram, NY 11727-5169

National Provider Directory

National Provider Directory
Tax ID family
Didi Hirsch Mental Health Services140 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487850251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 AVALON PINES DR",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117275169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 AVALON PINES DR",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117275169",
            "telephone_number": "917-699-3460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK UNIVERSITY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "CAREN",
        "authorized_official_title_or_position": "RESIDENT PHYSICIAN",
        "authorized_official_telephone_number": "917-699-3460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coram, NY

Sources for this page

  • 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.