NPIMap

Organization Active NPI

Stony Brook Dermatology Associates, University Faculty Practice Corpor

  • Dermatology Physician
  • Stony Brook, NY
National Provider Identifier
1497700819
Registry record updated Jan 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
STONY BROOK DERMATOLOGY ASSOCIATES, UNIVERSITY FACULTY PRACTICE CORPOR
Practice address
Suny @ Stony Brook
HSC, L16, RM 060
Stony Brook, NY 11794-0001
Phone
(631) 444-7597
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2015

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

Authorized official

Name
Dr. Evan Jones, M.D.NPI 1104865831
Title
Chair Person
Phone
(631) 444-7597

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
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

Suny @ Stony Brook
HSC, L16, RM 060
Stony Brook, NY 11794-0001

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-7597

Other identifiers 1

IdentifierTypeStateIssuer
01193984MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318001322 NY Part B Supplier - Clinic/Group Practice 3971493206 Receives reassigned benefits from 11 practitioners
Practice locations: Commack, NY; Stony Brook, NY; Stonybrook, NY

National Provider Directory

National Provider Directory

Locations

500 Commack Rd
Ste 102B
Commack, NY 11725

1320 Stony Brook Rd
Bldg F
Stony Brook, NY 11790
Phone (631) 368-3056

Suny Stony Brk
Stony Brook, NY 11794
Phone (631) 444-2448

100 Nicolls Rd
#8165
Stony Brook, NY 11794

1320 Stony Brook Rd
Ste 2
Stony Brook, NY 11790

1320 Stony Brook Rd
Bldg F200
Stony Brook, NY 11790
Phone (631) 444-3843

1320 Stony Brook Rd
Ste 200
Stony Brook, NY 11790
Phone (631) 444-4272

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

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": "1421884800000",
    "number": "1497700819",
    "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": "631-444-7597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "HSC, L16, RM 060",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-7597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK DERMATOLOGY ASSOCIATES, UNIVERSITY FACULTY PRACTICE CORPOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "EVAN",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-7597",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01193984",
            "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 Jan 22, 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.