Healthcare Provider Details

I. General information

NPI: 1861889461
Provider Name (Legal Business Name): NORTH SHORE -LIJ OB-GYN AT NEW HYDE PARK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 NEW HYDE PARK RD SUITE 407
NEW HYDE PARK NY
11042-1206
US

IV. Provider business mailing address

3003 NEW HYDE PARK RD
NEW HYDE PARK NY
11042-1206
US

V. Phone/Fax

Practice location:
  • Phone: 516-823-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELE CUSAK
Title or Position: CFO
Credential:
Phone: 516-465-8162