Provider Demographics
NPI:1700175270
Name:NORTH SHORE LIJ MEDICAL GROUP AT NORTH NASSAU, PC
Entity Type:Organization
Organization Name:NORTH SHORE LIJ MEDICAL GROUP AT NORTH NASSAU, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-465-8182
Mailing Address - Street 1:972 BRUSH HOLLOW RD
Mailing Address - Street 2:FINANCE 5TH FLOOR
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1740
Mailing Address - Country:US
Mailing Address - Phone:516-876-6065
Mailing Address - Fax:
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2855
Practice Address - Country:US
Practice Address - Phone:516-484-7893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty