NPIMap

Organization Active NPI

Long Island Jewish Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Queens Village, NY
National Provider Identifier
1093723488
Registry record updated Nov 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
7003004H Issued in NY
Legal business name
LONG ISLAND JEWISH MEDICAL CENTER
Practice address
22022 Hillside Avenue
Queens Village, NY 11427-2020
Phone
(516) 876-6000
Fax
(516) 876-6600
NPI assigned
Aug 3, 2006
Organization subpart
Yes
Parent organization
LONG ISLAND JEWISH MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2018

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

Authorized official

Name
Mrs. Michele Lee Cusack
Title
Senior Vice President & Cfo
Phone
(516) 321-6058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 7003004H NY Primary

Addresses

Primary practice location

22022 Hillside Avenue
Queens Village, NY 11427-2020

Mailing address

972 Brush Hollow Rd
5TH Flooor Finance
Westbury, NY 11590-1740
Phone (516) 876-6000

Other names 1

  • End Stage Renal Dialysis Facility Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210615001267 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 2567375421 Practice locations: Queens Village New, NY

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Janet C Hoffman

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

22022 Hillside Ave
Queens Village, NY 11427
Phone (718) 975-1311

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1093723488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 BRUSH HOLLOW RD",
            "address_2": "5TH FLOOOR FINANCE",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115901740",
            "telephone_number": "516-876-6000",
            "fax_number": "516-876-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22022 HILLSIDE AVENUE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114272020",
            "telephone_number": "516-876-6000",
            "fax_number": "516-876-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND JEWISH MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONG ISLAND JEWISH MEDICAL CENTER",
        "enumeration_date": "2006-08-03",
        "last_updated": "2018-11-28",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": "7003004H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "End Stage Renal Dialysis Facility",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "End Stage Renal Dialysis Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Queens Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; 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.