Healthcare Provider Details

I. General information

NPI: 1295743060
Provider Name (Legal Business Name): GLEN COVE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT ANDREWS LN
GLEN COVE NY
11542-2254
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD 5TH FLOOR FIANCE ATTN WILLIAM J FUCHS
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 516-674-7300
  • Fax:
Mailing address:
  • Phone: 516-876-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number003232
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELE LEE CUSACK
Title or Position: SENIOR VP & CFO
Credential:
Phone: 516-321-6058