MEDICARE: LONG ISLAND COLLEGE HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit	5131992DUP	NY

General Provider Information

NPI Number	:	1811229206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND COLLEGE HOSPITAL

Provider Business Mailing Address
First Line	:	444 E 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3522
Country	:	US
Telephone Number	:	212-223-8181
Fax Number	:	212-223-8181

Provider Business Practice Location Address
First Line	:	444 E 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3522
Country	:	US
Telephone Number	:	212-223-8181
Fax Number	:	212-223-8181

Authorized Official
Title or Position	:	CHARIMAN
Name	:	JASON HERSHBERGER
Credential	:	M.S.
Telephone Number	:	718-780-1065

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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