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General NPI Number Information
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NPI Number | 1619316718
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Entity Type | Organization
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Legal Business Name | NORTH SHORE-LIJ HEALTH PLAN
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 145 COMMUNITY DR
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City | GREAT NECK
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State | NY
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Zip | 11021-5502
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Country | US
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Telephone | 516-465-8106
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Fax |
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Provider Business Mailing Address
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Address Line | 145 COMMUNITY DR
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City | GREAT NECK
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State | NY
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Zip | 11021-5502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF MANAGED CARE
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Name | ROBERT BROWN
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Credential |
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Telephone | 516-465-8106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | NY
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