Provider Demographics
NPI:1609877364
Name:LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH
Entity Type:Organization
Organization Name:LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH
Other - Org Name:BROOKHAVEN MEMORIAL HOSPITAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP - CHIEF OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-654-7177
Mailing Address - Street 1:105 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3003
Mailing Address - Country:US
Mailing Address - Phone:631-687-2960
Mailing Address - Fax:631-687-2970
Practice Address - Street 1:105 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3003
Practice Address - Country:US
Practice Address - Phone:631-687-2960
Practice Address - Fax:631-687-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5151500F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01143186Medicaid
NY004419OtherBLUE CROSS
NY331537Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID