1073585691 NPI number — LONG ISLAND JEWISH MEDICAL CENTER

Table of content: (NPI 1073585691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073585691 NPI number — LONG ISLAND JEWISH MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND JEWISH MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073585691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1983 MARCUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-326-6500
Provider Business Mailing Address Fax Number:
516-326-9282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1983 MARCUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-326-6500
Provider Business Practice Location Address Fax Number:
516-326-9282
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUSACK
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR VICE PRESIDENT & CFO
Authorized Official Telephone Number:
516-321-6058

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7003608 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 337170 . This is a "HORIZON HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: IC0905 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00243903 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 99343 . This is a "PRUCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC1425 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: ON05439 . This is a "MDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000223 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0502850 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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