Provider Demographics
NPI:1417019217
Name:LONG ISLAND COLLEGE HOSPITAL
Entity Type:Organization
Organization Name:LONG ISLAND COLLEGE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-523-7140
Mailing Address - Street 1:160 WATER STREET
Mailing Address - Street 2:ROOM 2329
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-256-3027
Mailing Address - Fax:212-256-3595
Practice Address - Street 1:339 HICKS STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-780-1000
Practice Address - Fax:212-256-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001017H273R00000X, 273Y00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered273R00000XHospital UnitsPsychiatric Unit
Not Answered273Y00000XHospital UnitsRehabilitation Unit
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243678Medicaid
NY000060OtherBLUE CROSS
33T152Medicare ID - Type Unspecified
NY000060OtherBLUE CROSS
330152Medicare ID - Type Unspecified