Provider Demographics
NPI:1841320967
Name:LONG ISLAND JEWISH MEDICAL CENTER
Entity type:Organization
Organization Name:LONG ISLAND JEWISH MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:718-470-8055
Mailing Address - Street 1:36 GRANT WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1693
Mailing Address - Country:US
Mailing Address - Phone:609-279-0351
Mailing Address - Fax:718-962-2742
Practice Address - Street 1:7559 263 STREET
Practice Address - Street 2:LOWENSTEIN PAVILION 140
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-470-8341
Practice Address - Fax:718-962-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002774-1273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit