Healthcare Provider Details

I. General information

NPI: 1134341779
Provider Name (Legal Business Name): LONG ISLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HICKS ST
BROOKLYN NY
11201-5509
US

IV. Provider business mailing address

3026 GOMER ST
YORKTOWN HEIGHTS NY
10598-2724
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1927
  • Fax:
Mailing address:
  • Phone: 646-209-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number209849
License Number StateNY

VIII. Authorized Official

Name: DR. TUCKER WOODS
Title or Position: ASS DIRECTOR ER
Credential: MD
Phone: 718-780-1927