NPIMap

Organization Active NPI

North Shore - Lij Pediatrics of Suffolk County, P.C.

  • Pediatrics Physician
  • Islandia, NY
National Provider Identifier
1255722161
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTH SHORE - LIJ PEDIATRICS OF SUFFOLK COUNTY, P.C.
Practice address
1770 Motor Pkwy
Islandia, NY 11749-5260
Phone
(516) 823-8997
NPI assigned
Feb 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 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) 465-8162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1770 Motor Pkwy
Islandia, NY 11749-5260

Mailing address

600 Community Dr
Manhasset, NY 11030-3802
Phone (516) 823-8997

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160222001466 NY Part B Supplier - Clinic/Group Practice 6406151919 Receives reassigned benefits from 23 practitioners
Practice locations: New Hyde Park, NY; Stony Brook, NY; Smithtown, NY; Rockville Centre, NY; Port Jefferson, NY; Mount Sinai, NY; Islandia, NY; Bay Shore, NY

National Provider Directory

National Provider Directory

Locations

4300 Hempstead Tpke
Bethpage, NY 11714
Phone (516) 210-8200

285 Sills Rd
Bldg A
East Patchogue, NY 11772

3001 Express Dr N
Ste 100
Islandia, NY 11749
Phone (631) 434-1770

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1255722161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COMMUNITY DR",
            "city": "MANHASSET",
            "state": "NY",
            "postal_code": "110303802",
            "telephone_number": "516-823-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 MOTOR PKWY",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495260",
            "telephone_number": "516-823-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE - LIJ PEDIATRICS OF SUFFOLK COUNTY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "CUSAK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "516-465-8162",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "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 26, 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.