Healthcare Provider Details

I. General information

NPI: 1922543602
Provider Name (Legal Business Name): LONG ISLAND JEWISH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD 5TH FLOOR
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 516-465-8089
  • Fax:
Mailing address:
  • Phone: 516-876-6065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT S SHAPIRO
Title or Position: EXEC. VICE PRESIDENT AND CFO
Credential:
Phone: 516-321-6025