Provider Demographics
NPI:1679805725
Name:NORTHSHORELIJ HOSPITAL
Entity Type:Organization
Organization Name:NORTHSHORELIJ HOSPITAL
Other - Org Name:NORTHSHOREEXTENDED CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENCE PRACTICAL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:04 09 1959
Authorized Official - Phone:718-479-7113
Mailing Address - Street 1:22218 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1634
Mailing Address - Country:US
Mailing Address - Phone:718-479-7113
Mailing Address - Fax:718-479-7113
Practice Address - Street 1:22218 100TH AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1634
Practice Address - Country:US
Practice Address - Phone:718-479-7113
Practice Address - Fax:718-479-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-30
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21544589251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care