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General NPI Number Information
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NPI Number | 1831494061
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Entity Type | Organization
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Legal Business Name | NORTH SHORE - LIJ MEDICAL GROUP AT SYOSSET PC
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 8 GREENFIELD RD
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City | SYOSSET
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State | NY
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Zip | 11791-4831
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Country | US
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Telephone | 516-465-8162
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Fax |
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Provider Business Mailing Address
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Address Line | 600 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3802
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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 | CFO
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Name | MRS. MICHELE CUSAK
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Credential |
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Telephone | 516-465-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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