Provider Demographics
NPI:1114981248
Name:LONG ISLAND COLLEGE HOSP
Entity Type:Organization
Organization Name:LONG ISLAND COLLEGE HOSP
Other - Org Name:LONG ISLAND COLLEGE PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN DEPT OF PATHOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:ELPIDIO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-780-1005
Mailing Address - Street 1:1900 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:516-794-8165
Practice Address - Street 1:339 HICKS STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5514
Practice Address - Country:US
Practice Address - Phone:718-780-1727
Practice Address - Fax:718-780-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZYTX1Medicare PIN