Provider Demographics
| NPI: | 1215019500 |
|---|---|
| Name: | NORTH SHORE LONG ISLAND JEWISH HEALTH CARE INC |
| Entity Type: | Organization |
| Organization Name: | NORTH SHORE LONG ISLAND JEWISH HEALTH CARE INC |
| Other - Org Name: | NORTH SHORE LONG ISLAND JEWISH HEALTH CARE INC |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | SENIOR VICE PRESIDENT & CFO |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | MICHELE |
| Authorized Official - Middle Name: | LEE |
| Authorized Official - Last Name: | CUSACK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 516-321-6058 |
| Mailing Address - Street 1: | 972 BRUSH HOLLOW RD |
| Mailing Address - Street 2: | 5TH FLOOR FINANCE ATTN: WILLIAM J. FUCHS |
| Mailing Address - City: | WESTBURY |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 11590-1740 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 516-876-6065 |
| Mailing Address - Fax: | 516-876-5572 |
| Practice Address - Street 1: | 972 BRUSH HOLLOW RD |
| Practice Address - Street 2: | 5TH FLOOR FINANCE ATTN: WILLIAM J. FUCHS |
| Practice Address - City: | WESTBURY |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 11590 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 516-876-6000 |
| Practice Address - Fax: | 516-876-6600 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-10-19 |
| Last Update Date: | 2018-07-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | WZZWR1 | Medicare PIN | |
| NY | WANM72 | Medicare PIN | |
| NY | WANM71 | Medicare PIN | |
| NY | WZZWP1 | Medicare PIN | |
| NY | 07950 | Medicare PIN | |
| NY | WW2T11 | Medicare PIN | |
| NY | WANM73 | Medicare PIN | |
| NY | 07950A | Medicare PIN |
