Healthcare Provider Details

I. General information

NPI: 1437337847
Provider Name (Legal Business Name): NORTHSHORE-LONG ISLAND JEWISH HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COMMUNITY DR
GREAT NECK NY
11021-5504
US

IV. Provider business mailing address

126 COVERT AVE
FLORAL PARK NY
11003-1133
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-8855
  • Fax: 516-465-8890
Mailing address:
  • Phone: 516-852-9283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberF334779
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberF334779
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberF334779
License Number StateNY

VIII. Authorized Official

Name: MS. KIM L WHYTE
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 516-488-2662