NPIMap

Organization Active NPI

Stony Brook Pathologists, University Faculty Practice Corporation

  • Anatomic Pathology & Clinical Pathology Physician
  • Stony Brook, NY
National Provider Identifier
1912944794
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
STONY BROOK PATHOLOGISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Practice address
Suny @ Stony Brook
BHS, L9, RM 140
Stony Brook, NY 11790
Phone
(631) 444-3000
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Authorized official

Name
Kenneth Shroyer, M.D.NPI 1902825557
Title
Chair Person
Phone
(631) 444-3000

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
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

Suny @ Stony Brook
BHS, L9, RM 140
Stony Brook, NY 11790

Mailing address

PO Box 1554
Stony Brook, NY 11790-0988
Phone (631) 444-3000

Other identifiers 1

IdentifierTypeStateIssuer
00821403MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080103000301 NY Part B Supplier - Clinic/Group Practice 2163502162 Receives reassigned benefits from 24 practitioners
Practice locations: Southampton, NY; Stony Brook, NY
O20191210001366 NY Part B Supplier - Independent Clinical Laboratory 2163502162 Practice locations: Stony Brook, NY

National Provider Directory

National Provider Directory

Locations

240 Meeting House Ln
Southampton, NY 11968
Phone (631) 726-0409

Lauterbur Dr
Stony Brook, NY 11794
Phone (631) 638-1000

1320 Stony Brook Rd
#200
Stony Brook, NY 11790
Phone (631) 638-3056

Practitioners & affiliated clinicians

Practitioners 40

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

View all 40

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": "1424822400000",
    "number": "1912944794",
    "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": "631-444-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNY @ STONY BROOK",
            "address_2": "BHS, L9, RM 140",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11790",
            "telephone_number": "631-444-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONY BROOK PATHOLOGISTS, UNIVERSITY FACULTY PRACTICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "SHROYER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CHAIR PERSON",
        "authorized_official_telephone_number": "631-444-3000",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00821403",
            "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 Feb 25, 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.