Organization
STONY BROOK UROLOGY, UNIVERSITY FACULTY PRACTICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE WALTZER M.D. (CHAIR PERSON)
(631) 444-1252
Entity
Organization
Contact information
Practice address
24 RESEARCH WAY, SUITE 500, EAST SETAUKET, NY 11733-3487
(631) 444-6270
Mailing address
PO BOX 1554, STONY BROOK, NY 11790-0988
(631) 444-1252
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00778890
—
NY
Enumeration date
05/24/2006
Last updated
06/20/2019
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