Provider Demographics
NPI:1669695797
Name:LONG ISLAND COLLEGE HOSPITAL
Entity type:Organization
Organization Name:LONG ISLAND COLLEGE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, ORTHOPEDICS DEPT.
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-780-4705
Mailing Address - Street 1:97 AMITY STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-780-4705
Mailing Address - Fax:718-780-1396
Practice Address - Street 1:97 AMITY STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-780-4705
Practice Address - Fax:718-780-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003327 1363A00000X
NY003327-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003327-1OtherLICENSE #
NY0TH000Medicare UPIN