| Organization Name: | STONY BROOK UNIVERSITY MEDICAL CENTER |
| NPI Number: | 1487850251 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JILL CAREN BERGSON (RESIDENT PHYSICIAN) |
| Mailing Address: | 2428 Avalon Pines Dr Coram |
| State: | NY US |
| Postal Code: | 117275169 |
| Phone Number: | 9176993460 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |