Organization
STONY BROOK PREVENTIVE MEDICINE SERVICES, UNIV FCLTY PRACTICE CORP
Active
Organization
STONY BROOK PREVENTIVE MEDICINE SERVICES, UNIV FCLTY PRACTICE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRIS A GRANEK M.D. (PRESIDENT)
(631) 444-2189
Entity
Organization
Contact information
Practice address
SUNY @ STONY BROOK, HSC, L3, RM 086, STONY BROOK, NY 11794-0001
(631) 444-2189
Mailing address
PO BOX 1554, STONY BROOK, NY 11790-0988
(631) 444-2189
Taxonomy
Speciality
Code
Description
License number
State
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00994812
—
NY
Enumeration date
05/26/2006
Last updated
02/06/2015
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