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General NPI Number Information
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NPI Number | 1942666557
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Entity Type | Organization
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Legal Business Name | NORTH SHORE-LIJ MEDICAL GROUP P.C.
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 300 COMMUNITY DR
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City | MANHASSET
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State | NY
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Zip | 11030-3816
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Country | US
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Telephone | 516-876-5555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11173
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City | NEW YORK
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State | NY
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Zip | 10087-1173
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Country | US
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Telephone | 516-876-5555
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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 | 516-321-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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