Provider Demographics
NPI:1932125911
Name:NASSAU HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:NASSAU HEALTH CARE CORPORATION
Other - Org Name:NUMC DEPARTMENT OF OB/GYN, FPP
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAGH-LANTIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-572-5135
Mailing Address - Street 1:2201 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1859
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2201 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1859
Practice Address - Country:US
Practice Address - Phone:516-572-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASSAU HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2950002H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02054924Medicaid
NY02054924Medicaid