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184d Nichols Road Sullivan Hall Stony Brook NY 11794 | |
| (631) 632-8966 | |
| (631) 632-9302 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 184d Nichols Road Sullivan Hall, Stony Brook, New York |
| Authorized Official Name and Position | Carol Sloane (ASST. DEAN CLINIC OPERATIONS) |
| Authorized Official Contact | 6316328966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
184d Nichols Road Sullivan Hall Stony Brook NY 11794-0001 Ph: (631) 632-8966 | 184d Nichols Road Sullivan Hall Stony Brook NY 11794 Ph: (631) 632-8966 |
| NPI Number | 1053482067 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 08/03/2018 |
| Medicare PECOS PAC ID | 0840101770 |
|---|---|
| Medicare Enrollment ID | O20170926003852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053482067 | NPI | - | NPPES |
| 00475076 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 377821 (New York) | Primary |
| Provider Name | Steven Marshall Zove |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1902929706 PECOS PAC ID: 6002114865 Enrollment ID: I20181115000870 |
| Provider Name | Brian Howe |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1003945437 PECOS PAC ID: 7911207055 Enrollment ID: I20240722003023 |
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