Provider Demographics
NPI:1376841056
Name:NORTH SHORE UNIVERSITY HOSPITAL AMBULANCE
Entity type:Organization
Organization Name:NORTH SHORE UNIVERSITY HOSPITAL AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-321-6058
Mailing Address - Street 1:300 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:972 BRUSH HOLLOW RD
Practice Address - Street 2:FINANCE 5TH FLOOR
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1740
Practice Address - Country:US
Practice Address - Phone:516-876-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORE UNIVERSITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-04
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY330106Medicare Oscar/Certification