Healthcare Provider Details

I. General information

NPI: 1174530349
Provider Name (Legal Business Name): LONG ISLAND JEWISH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD FL 5
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3000
  • Fax:
Mailing address:
  • Phone: 516-876-6000
  • Fax: 516-876-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number7003004H
License Number StateNY

VIII. Authorized Official

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