Healthcare Provider Details

I. General information

NPI: 1710122627
Provider Name (Legal Business Name): LONG ISLAND COLLEGE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HICKS ST
BROOKLYN NY
11201-5509
US

IV. Provider business mailing address

160 WATER ST SUITE 2329
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-3027
  • Fax: 212-256-3595
Mailing address:
  • Phone: 212-256-3027
  • Fax: 212-256-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number700101H
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL BRUNO
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 212-256-3027