Provider Demographics
NPI:1609327618
Name:GLEN COVE HOSPITAL
Entity Type:Organization
Organization Name:GLEN COVE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:516-674-7300
Mailing Address - Street 1:101 SAINT ANDREWS LN
Mailing Address - Street 2:FOOD AND NUTRITION DEPARTMENT
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2254
Mailing Address - Country:US
Mailing Address - Phone:516-674-7472
Mailing Address - Fax:
Practice Address - Street 1:101 SAINT ANDREWS LN
Practice Address - Street 2:FOOD AND NUTRITION DEPARTMENT
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2254
Practice Address - Country:US
Practice Address - Phone:516-674-7472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWELL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281P00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No282N00000XHospitalsGeneral Acute Care Hospital