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General NPI Number Information
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NPI Number | 1922543602
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Entity Type | Organization
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Legal Business Name | LONG ISLAND JEWISH MEDICAL CENTER
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 27005 76TH AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1402
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Country | US
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Telephone | 516-465-8089
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Fax |
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Provider Business Mailing Address
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Address Line | 972 BRUSH HOLLOW RD 5TH FLOOR
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City | WESTBURY
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State | NY
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Zip | 11590-1740
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Country | US
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Telephone | 516-876-6065
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Fax |
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Authorized Official
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Title or Position | EXEC. VICE PRESIDENT AND CFO
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Name | MR. ROBERT S SHAPIRO
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Credential |
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Telephone | 516-321-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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