NPIMap

Individual provider Active NPI

Amanda B Sosulski, M.D.

  • Surgery Physician
  • Stony Brook, NY
National Provider Identifier
1962636332
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
292805 Issued in NY
Practice address
Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-0001
Phone
(631) 444-2754
Fax
(631) 444-6031
NPI assigned
May 13, 2009
Last updated
Apr 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Surgery Physician 208600000X 292805 NY Primary
Surgical Critical Care Physician 2086S0102X 292805 NY

Addresses

Primary practice location

Stony Brook University Hospital
Medical Staff Office T9
Stony Brook, NY 11794-0001

Mailing address

101 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-2754

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190919001317 NY Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 2163752098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

255 W Montauk Hwy
Life Care Ctr
Hampton Bays, NY 11946
Phone (631) 723-5000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
292805NYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Stony Brook Surgical Associates, University Faculty Practice Corporati Surgery CurrentSince Apr 1, 2022 Accepting new patients
SBH Physicians, PC CurrentSince Sep 3, 2019 Accepting new patients
SBH Physicians, PC Surgery CurrentSince Sep 3, 2019 Accepting new patients
University Hospital at Stony Brook Past Accepting new patients

Locations

111 E 210th St
Bronx, NY 10467

4422 3rd Ave
Bronx, NY 10457
Phone (718) 960-3917

4487 3rd Ave
Bronx, NY 10457
Phone (718) 960-3730

37 Research Way
Setauket, NY 11733
Phone (631) 444-4121

101 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-2065

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 4

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

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1962636332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11794",
            "telephone_number": "631-444-2754",
            "fax_number": "631-444-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STONY BROOK UNIVERSITY HOSPITAL",
            "address_2": "MEDICAL STAFF OFFICE T9",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-2754",
            "fax_number": "631-444-6031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOSULSKI",
        "first_name": "AMANDA",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "292805",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NY",
            "license": "292805",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.