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Long Island Jewish Medical Center

Organization Active NPI Mental Illness Community Based Residential Treatment Facility · New Hyde Park, NY

NPI 1104990928 · NPPES record last updated Nov 28, 2018

Key facts

NPI
1104990928
Entity type
Organization (NPI type 2)
Primary specialty
Mental Illness Community Based Residential Treatment Facility 320800000X
Legal business name
LONG ISLAND JEWISH MEDICAL CENTER
Practice address
27005 76TH Ave
New Hyde Park, NY 11040-1433
Phone
(516) 876-6000
Fax
(516) 876-6600
NPI assigned
Nov 20, 2006
Organization subpart
No

Authorized official

Name
Mrs. Michele Lee Cusack
Title
Senior Vice President & Cfo
Phone
(516) 876-1386

Corporate family (same tax ID) 18

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Janet C Hoffman (19 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Yes

Addresses

Primary practice location

27005 76TH Ave
New Hyde Park, NY 11040-1433

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
1321493MedicaidNY

Other names

  • Long Island Jewish Community Residents Program Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 28, 2018.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543363200000",
    "number": "1104990928",
    "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",
            "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": "27005 76TH AVE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110401433",
            "telephone_number": "516-876-6000",
            "fax_number": "516-876-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND JEWISH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "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": "516-876-1386",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1321493",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Island Jewish Community Residents Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Hyde Park, NY

All providers in New Hyde Park, NY · Mental Illness Community Based Residential Treatment Facility in New York

Sources for this page

Verify at the official NPI Registry.