Individual
DR. THEODORE F PACKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UNIVERSITY HOSPITAL, L4, STONY BROOK, NY 11794-0001
(631) 444-2499
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-2499
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
161826
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00971875
—
NY
01
—
4260016
AETNA
NY
01
—
62F061
EMPIRE BC.BS
NY
Enumeration date
06/19/2006
Last updated
07/08/2007
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