Provider Demographics
NPI:1619316718
Name:NORTH SHORE-LIJ HEALTH PLAN
Entity Type:Organization
Organization Name:NORTH SHORE-LIJ HEALTH PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-465-8106
Mailing Address - Street 1:145 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5502
Practice Address - Country:US
Practice Address - Phone:516-465-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORE-LIJ HEALTH PLAN HOLDING COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-21
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
1100089256OtherNYS VENDOR IDENTIFICATION