Benjamin Elie Fombonne, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

314533 Issued in NY

Practice address

101 Nicolls Rd RM 50
Stony Brook, NY 11794-0001

Phone

(631) 444-2499

Fax

(631) 444-3919

NPI assigned

Mar 21, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stony Brook Emergency Physicians, University Faculty Practice Corporat

  • Emergency Medicine Physician
  • Stony Brook, NY
  • NPI 1265487672
  Medicare reassignment NPD

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1932669439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 WHITTIER PL",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771619",
            "telephone_number": "202-549-8587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD RM 50",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-2499",
            "fax_number": "631-444-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMBONNE",
        "first_name": "BENJAMIN",
        "middle_name": "ELIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-21",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "314533",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Ann Floyd
• Laura Fochtmann, M.D.
• Elizabeth Amy Foley, NNP-BC
• Nancy Marie Foley, NP
• Annemarie C Folken, NP
• Sheri Ford
• Nicole Ann Forman, FNP
• Antoinette Forster, N.P.
• Lorie-Ann Foster, MD
• Andrea Fowora

• Emergency Medicine Physician in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.