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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