NPIMap

Organization Active NPI

Stony Brook Radiation Oncology, University Faculty Practice Corporatio

  • Radiation Oncology Physician
  • Stony Brook, NY
National Provider Identifier
1730126517
Registry record updated Dec 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
STONY BROOK RADIATION ONCOLOGY, UNIVERSITY FACULTY PRACTICE CORPORATIO
Practice address
Suny @ Stony Brook
HSC, L2, RM 643
Stony Brook, NY 11797
Phone
(631) 444-2206
NPI assigned
Jun 1, 2006
Last updated
Dec 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2014

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

Authorized official

Name
Samuel Ryu, M.D.NPI 1639239049
Title
Chair Person
Phone
(631) 444-2206

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
Radiation Oncology Physician 2085R0001X Primary

Addresses

Primary practice location

Suny @ Stony Brook
HSC, L2, RM 643
Stony Brook, NY 11797

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-2206

Other identifiers 1

IdentifierTypeStateIssuer
00822642MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323001597 NY Part B Supplier - Clinic/Group Practice 7214828706 Receives reassigned benefits from 7 practitioners
Practice locations: Southampton, NY; Stony Brook, NY

National Provider Directory

National Provider Directory

Locations

5 Hsc Level
Stony Brook, NY 11794
Phone (631) 444-2336

Hsp L2
Stony Brook, NY 11794
Phone (631) 444-2210

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419206400000",
    "number": "1730126517",
    "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": "631-444-2206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "HSC, L2, RM 643",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11797",
            "telephone_number": "631-444-2206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK RADIATION ONCOLOGY, UNIVERSITY FACULTY PRACTICE CORPORATIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2014-12-22",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-2206",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00822642",
            "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 Dec 22, 2014; 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.