Provider Demographics
NPI:1285641514
Name:LONG ISLAND JEWISH MEDICAL CENTER
Entity Type:Organization
Organization Name:LONG ISLAND JEWISH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
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 1:972 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:516-876-6000
Mailing Address - Fax:516-876-6600
Practice Address - Street 1:270-05 76 AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
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:2006-08-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003004H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY330195OtherMEDICARE CCN
NY33019501OtherMEDICARE CCN LIJ VALLEY STREAM