Provider Demographics
NPI:1679970891
Name:NORTH SHORE LIJ, URGENT CARE, P.C.
Entity Type:Organization
Organization Name:NORTH SHORE LIJ, URGENT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-279-2917
Mailing Address - Street 1:5555 GLENRIDGE CONNECTOR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4758
Mailing Address - Country:US
Mailing Address - Phone:516-321-4967
Mailing Address - Fax:516-734-6729
Practice Address - Street 1:265 SUNRISE HWY STE 20
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4912
Practice Address - Country:US
Practice Address - Phone:516-321-4967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care