Healthcare Provider Details

I. General information

NPI: 1609877364
Provider Name (Legal Business Name): NYU LANGONE HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEST MAIN STREET
PATCHOGUE NY
11772-3003
US

IV. Provider business mailing address

105 WEST MAIN STREET
PATCHOGUE NY
11772-3003
US

V. Phone/Fax

Practice location:
  • Phone: 631-687-2960
  • Fax: 631-687-2970
Mailing address:
  • Phone: 631-687-2960
  • Fax: 631-687-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number5151500F
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier004419
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CROSS
# 2
Identifier01143186
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. MARC ADLERQ
Title or Position: SR VP-CHIEF OF HOSPITAL OPERATIONS
Credential:
Phone: 631-654-7177