Provider Demographics
NPI:1821418310
Name:NORTH SHORE LONG ISLAND JEWISH
Entity type:Organization
Organization Name:NORTH SHORE LONG ISLAND JEWISH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-868-1400
Mailing Address - Street 1:1600 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4000
Mailing Address - Country:US
Mailing Address - Phone:718-868-1400
Mailing Address - Fax:718-327-5615
Practice Address - Street 1:1600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4000
Practice Address - Country:US
Practice Address - Phone:718-868-1400
Practice Address - Fax:718-327-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083653283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital