Healthcare Provider Details

I. General information

NPI: 1710363361
Provider Name (Legal Business Name): NORTHSHORE LIJ HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 COMMUNITY DR
MANHASSET NY
11030-3804
US

IV. Provider business mailing address

302 COMMUNITY DR
MANHASSET NY
11030-3804
US

V. Phone/Fax

Practice location:
  • Phone: 917-530-8380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VICTORIA WAYTHE
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 718-470-4475