Basic Information
| Provider Information | |||||||||
| NPI: | 1396753224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND JEWISH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 972 BRUSH HOLLOW RD | ||||||||
| Address2: | 5TH FLOOR FINANCE ATTN: WILLIAM J. FUCHS | ||||||||
| City: | WESTBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115901740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168766000 | ||||||||
| FaxNumber: | 5168766600 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 FRANKLIN AVE | ||||||||
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| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115802145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165628070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | CUSACK | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT & CFO | ||||||||
| AuthorizedOfficialTelephone: | 5163216058 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 2910000N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.