DR. ANDREW WACKETT (NPI# 1649215740) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649215740 |
| Entity Type | Individual |
| Full Name | DR. ANDREW WACKETT |
| Credential | M.D. |
| Practice Address |
University Hospital, L4 Stony Brook NY 11794-0001 |
| Mailing Address |
Po Box 1559 Stony Brook NY 11790-0989 |
| Practice Telephone | 6314442499 |
| Mailing Telephone | 6314442499 |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 213860 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | EMPIRE BC.BS | 62Q082 | 01 |
| NY | AETNA | 7074586 | 01 |
| NY | 02108478 | 05 |
| Street Address |
UNIVERSITY HOSPITAL, L4 |
| City | STONY BROOK |
| State | NY |
| Zip Code | 11794-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740221159 | Margaret Johnstone | Radiology | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-08 |
| 1811929664 | Gregory Garra | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-07-06 |
| 1720010572 | Scott Johnson | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-07-06 |
| 1730117367 | John E Leavens | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-30 |
| 1902835333 | David Cohen | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-30 |
| 1780612648 | Sayed M. Khwaja | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-29 |
| 1891723698 | Adam Singer | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-29 |
| 1093743932 | Frederick Schiavone | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-29 |
| 1225066905 | Mark Henry | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-29 |
| 1831127752 | Donna Venezia | Emergency Medicine | University Hospital, L4, Stony Brook, NY 11794-0001 | 2006-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619506714 | Ryan John Kottmeier | Physician Assistant | 101 Nicolls Road Suny Stony Brook Hospital, Dept of Orthopedics Hsc T18, Room 080, Stony Brook, NY 11794 | 2020-04-02 |
| 1699302109 | Michael Trentalange | Student in an Organized Health Care Education/Training Program | Department of Surgery, Health Sciences Center Level 19, Room 030, Stony Brook, NY 11794 | 2020-03-25 |
| 1164985156 | Lauren Kate Harris | Student in an Organized Health Care Education/Training Program | Stony Brook Medicine, Department of Ob/gyn, Hsc T9, 101 Nicolls Road, Stony Brook, NY 11794 | 2019-04-08 |
| 1851851448 | Kathy Tin | Student in an Organized Health Care Education/Training Program | Dept of Medicine Hsc 16 Suny Stony Brook Hospital, Stony Brook, NY 11794 | 2019-03-21 |
| 1174083703 | Arham Khan | Student in an Organized Health Care Education/Training Program | Dept of Medicine Hsc Level 16, Suny Stony Brook Hosp, Stony Brook, NY 11794 | 2019-03-20 |
| 1396221982 | Aman Bhojani | Student in an Organized Health Care Education/Training Program | Suny At Stony Brook Dental School, South Drive, Stony Brook, NY 11794 | 2018-07-17 |
| 1699265629 | Belliny Phaeton | Student in an Organized Health Care Education/Training Program | Stony Brook Children's Hospital, Hsc T-11, Room 040, Stony Brook, NY 11794 | 2018-05-15 |
| 1629568969 | Rachel Herold | Student in an Organized Health Care Education/Training Program | Stony Brook Children's Department of Pediatrics, Hsc T-11, Room 040, Stony Brook, NY 11794 | 2018-05-11 |
| 1598254419 | Nora Ann Diraimondo | Nurse Practitioner | Sb Hospital 101 Nicolls Road, Department of Medicine, Stony Brook, NY 11794 | 2018-05-07 |
| 1386140705 | Ryan Christopher Corn | Student in an Organized Health Care Education/Training Program | Dept. of Internal Medicine, Hsc Level 16-020, Suny Stony Brook, Stony Brook, NY 11794 | 2018-04-04 |
| Find all providers in zip 11794 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225560469 | Ali Shah Khan | Emergency Medicine | Hsc Level 4 Room 080 Stony Brook Hospital, Stony Brook, NY 11794-0001 | 2017-03-28 |
| 1902255318 | Marshall Leonard | Emergency Medicine | 100 Nicolls Rd, Hsc, L4 Rm 50, Stony Brook, NY 11794-0001 | 2016-06-07 |
| 1174971899 | Ashley Mogul | Emergency Medicine | Hsc Level 4 Room 080, Stony Brook Medicine, Department of Emergency Medicine, Stony Brook, NY 11794-8350 | 2016-06-03 |
| 1174995716 | Michelle M Tepper | Emergency Medicine | 100 Nichold Rd Emergency Medicine Level 4, Room 080, Stony Brook, NY 11790-1020 | 2015-10-22 |
| 1053799049 | Sarah Jennifer Weiss | Emergency Medicine | Stony Brook Hospital Department of Emergency, Hsc Level 4 Room 080, Stony Brook, NY 11794-8350 | 2015-05-11 |
| 1871971077 | Bryan Patrick English | Emergency Medicine | Stony Brook University Hospital Hsc L-4, Rm 080, Stony Brook, NY 11794 | 2015-05-08 |
| 1689060600 | David Hirsch Gordon | Emergency Medicine | Stony Brook Medicine - Em 100 Nicolls Road, Hsc, Level 4, Room 080, Stony Brook, NY 11794 | 2015-04-07 |
| 1740607068 | Hyunjoo Lee | Emergency Medicine | Stony Brook University Hospital Hsc L-4, Room 080, Stony Brook, NY 11794 | 2014-03-25 |
| 1861751489 | Jerome Wilkerson | Emergency Medicine | Stony Brook Medical Ctr Dept of Emergency, Hsc Level 4 Room 80, Stony Brook, NY 11794-8350 | 2012-05-16 |
| 1215227038 | Karalynn Otterness | Emergency Medicine | Stony Brook Medicine Department of Emergency, 100 Nicolls Road, Hsc, Level 4, Room 080, Stony Brook, NY 11794-8350 | 2011-04-13 |
| Find all providers in STONY BROOK | ||||
| City | STONY BROOK |
| Zip Code | 11794 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.