Basic Information
| Provider Information | |||||||||
| NPI: | 1467842393 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND JEWISH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7559 263RD ST | ||||||||
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| City: | GLEN OAKS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110041150 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 7559 263RD STREET @ 74TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | GLEN OAKS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110041050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184704834 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2015 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | DWYER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7184703521 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282NC2000X | N | Hospitals | General Acute Care Hospital | Children | 261QM0855X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.