Provider Demographics
NPI:1063469963
Name:LONG ISLAND COLLEGE HOSPITAL
Entity Type:Organization
Organization Name:LONG ISLAND COLLEGE HOSPITAL
Other - Org Name:LICH NEUROCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-780-1124
Mailing Address - Street 1:160 WATER ST
Mailing Address - Street 2:20FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-256-3682
Mailing Address - Fax:212-256-3538
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5509
Practice Address - Country:US
Practice Address - Phone:718-780-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86451Medicare PIN
NYW86451Medicare ID - Type Unspecified