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  7. NPI Record 1104865229

STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Complete NPI Record 1104865229
Internal Medicine - Pulmonary Disease in Stony Brook, NY

NPI Status: Active since June 05, 2006

Contact Information

SUNY @ STONY BROOK
HSC, L16, RM 020
STONY BROOK, NY
ZIP 11794
Phone: (631) 444-2448

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Second Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Authorized Official Last Name
  21. Authorized Official First Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Healthcare Provider Primary Taxonomy Switch 1
  26. Other Provider Identifier 1
  27. Other Provider Identifier Type Code 1
  28. Other Provider Identifier State 1
  29. Other Provider Identifier 2
  30. Other Provider Identifier Type Code 2
  31. Other Provider Identifier State 2
  32. Other Provider Identifier Issuer 2
  33. Is Organization Subpart
  34. Parent Organization LBN
  35. Parent Organization TIN
  36. Authorized Official Name Prefix Text
  37. Authorized Official Credential Text
  38. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1104865229. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1104865229
The last name of the provider. If the provider is an individual, this is the legal name.
Entity Type Code: 2
The first name of the provider, if the provider is an individual.
Employer Identification Number EIN: UNAVAIL
The middle name of the provider, if the provider is an individual.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider First Line Business Mailing Address: PO BOX 1554
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Mailing Address City Name: STONY BROOK
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address State Name: NY
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address Postal Code: 117900988
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Telephone Number: 6314442448
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: SUNY @ STONY BROOK
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Second Line Business Practice Location Address: HSC, L16, RM 020
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Practice Location Address City Name: STONY BROOK
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address State Name: NY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 117940001
The State code in the location of the provider being identified.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 6314442448
The country code in the location address of the provider being identified.
Provider Enumeration Date: 6/5/2006
The telephone number associated with the location address of the provider being identified.
Last Update Date: 11/21/2013
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Last Name: YANG
The date that a record was last updated or changed.
Authorized Official First Name: VINCENT
The code designating the provider’s gender if the provider is a person.
Authorized Official Title or Position: CHAIR PERSON
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Authorized Official Telephone Number: 6314442448
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Healthcare Provider Taxonomy Code 1: 207RP1001X
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: 00615265
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: NY
Other Provider Identifier 2: CB8937
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: NY
Other Provider Identifier Issuer 2: RAILROAD
Is Organization Subpart: Y
Parent Organization LBN: STONY BROOK INTERNISTS, UNIVERSITY FACULTY PRACTICE CORPORATION
Parent Organization TIN: UNAVAIL
Authorized Official Name Prefix Text: DR.
Authorized Official Credential Text: MD, PHD
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP