Provider Demographics
NPI:1275958050
Name:NORTH SHORE LIJ HEALTH SYSTEM
Entity Type:Organization
Organization Name:NORTH SHORE LIJ HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, FNP-C
Authorized Official - Phone:516-547-4930
Mailing Address - Street 1:221 SPORTSMANS AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5635
Mailing Address - Country:US
Mailing Address - Phone:516-547-4930
Mailing Address - Fax:
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3382311282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital