Provider Demographics
NPI:1376903351
Name:NORTHWELL
Entity Type:Organization
Organization Name:NORTHWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-941-1251
Mailing Address - Street 1:450 LAKEVILLE RD
Mailing Address - Street 2:DEPARTMENT OF SURGICAL ONCOLOGY
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1118
Mailing Address - Country:US
Mailing Address - Phone:516-487-9454
Mailing Address - Fax:
Practice Address - Street 1:450 LAKEVILLE RD
Practice Address - Street 2:DEPARTMENT OF SURGICAL ONCOLOGY
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1118
Practice Address - Country:US
Practice Address - Phone:516-487-9454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240304261Q00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02912843Medicaid
NYA400071309Medicare PIN