Provider Demographics
NPI:1073585691
Name:LONG ISLAND JEWISH MEDICAL CENTER
Entity Type:Organization
Organization Name:LONG ISLAND JEWISH MEDICAL CENTER
Other - Org Name:LONG ISLAND JEWISH MEDICAL CENTER HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-321-6058
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2000
Mailing Address - Country:US
Mailing Address - Phone:516-326-6500
Mailing Address - Fax:516-326-9282
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-326-6500
Practice Address - Fax:516-326-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003608251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
337170OtherHORIZON HEALTHCARE
IC0905OtherHEALTHNET
NY00243903Medicaid
99343OtherPRUCARE
ANC1425OtherOXFORD
ON05439OtherMDNY
NY000223OtherEMPIRE BCBS
0502850OtherAETNA
0=========OtherUNITED HEALTHCARE
337170OtherHORIZON HEALTHCARE
IC0905OtherHEALTHNET
ON05439OtherMDNY
=========OtherVYTRA
NY00243903Medicaid