NPIMap

Organization Active NPI

North Shore Lij OB GYN PC

  • Obstetrics Physician
  • Islandia, NY
National Provider Identifier
1033453329
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics PhysicianTaxonomy code 207VX0000X
Legal business name
NORTH SHORE LIJ OB GYN PC
Practice address
3001 Expressway Dr N
Islandia, NY 11749-5301
Phone
(631) 292-6747
Fax
(516) 876-6600
NPI assigned
Nov 27, 2012
Last updated
Jul 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Michele Cusak
Title
Cfo
Phone
(516) 465-8182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics Physician 207VX0000X NU Primary

Addresses

Primary practice location

3001 Expressway Dr N
Islandia, NY 11749-5301

Mailing address

972 Brush Hollow Rd
Westbury, NY 11590-1740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130329000011 NY Part B Supplier - Clinic/Group Practice 7214172980 Receives reassigned benefits from 25 practitioners
Practice locations: Smithtown, NY; New Hyde Park, NY; Islandia, NY; Huntington, NY; Manhasset, NY; Bay Shore, NY

National Provider Directory

National Provider Directory

Locations

300 Community Dr
Manhasset, NY 11030

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1033453329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 BRUSH HOLLOW RD",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115901740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 EXPRESSWAY DR N",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495301",
            "telephone_number": "631-292-6747",
            "fax_number": "516-876-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE LIJ OB GYN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-27",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "CUSAK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "516-465-8182",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Islandia, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.