Healthcare Provider Details

I. General information

NPI: 1609327618
Provider Name (Legal Business Name): GLEN COVE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT ANDREWS LN FOOD AND NUTRITION DEPARTMENT
GLEN COVE NY
11542-2254
US

IV. Provider business mailing address

101 SAINT ANDREWS LN FOOD AND NUTRITION DEPARTMENT
GLEN COVE NY
11542-2254
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-7472
  • Fax:
Mailing address:
  • Phone: 516-674-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNY

VIII. Authorized Official

Name: RACHEL WETZEL
Title or Position: CHIEF CLINICAL DIETITIAN
Credential: R.D.
Phone: 516-674-7300