Healthcare Provider Details

I. General information

NPI: 1841581659
Provider Name (Legal Business Name): LONG ISLAND COLLEGE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HICKS ST
BROOKLYN NY
11201-5509
US

IV. Provider business mailing address

94 AMITY ST APT 5A
BROOKLYN NY
11201-6021
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN WACHE THERMOLIVE
Title or Position: RESIDENT PHYSICIAN
Credential: M.D.
Phone: 718-780-2000