Provider Demographics
NPI:1881460681
Name:NORTH SHORE-LIJ OCCUPATIONAL MEDICINE
Entity type:Organization
Organization Name:NORTH SHORE-LIJ OCCUPATIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-492-3297
Mailing Address - Street 1:225 COMMUNITY DR STE 150
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5500
Mailing Address - Country:US
Mailing Address - Phone:516-492-3297
Mailing Address - Fax:
Practice Address - Street 1:225 COMMUNITY DR STE 150
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5500
Practice Address - Country:US
Practice Address - Phone:516-492-3297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty