NPIMap

Organization Active NPI

North Shore - Lij Internal Medicine at Lynbrook PC

Doing business as North Shore - LIJ Medical Group South Shore Medical Associates

  • Internal Medicine Physician
  • Lynbrook, NY
National Provider Identifier
1568898138
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NORTH SHORE - LIJ INTERNAL MEDICINE AT LYNBROOK PC
Doing business as
North Shore - LIJ Medical Group South Shore Medical Associates
Practice address
158 Hempstead Ave
Lynbrook, NY 11563-1605
Phone
(516) 593-3541
Fax
(516) 599-8307
NPI assigned
Sep 16, 2013
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) 562-8182

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary
Cardiovascular Disease Physician 207RC0000X
Gastroenterology Physician 207RG0100X
Pulmonary Disease Physician 207RP1001X

Addresses

Primary practice location

158 Hempstead Ave
Lynbrook, NY 11563-1605

Mailing address

972 Brush Hollow Rd
Finance 5TH Floor
Westbury, NY 11590-1740

Other names 1

  • North Shore - LIJ Medical Group South Shore Medical Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140115000883 NY Part B Supplier - Clinic/Group Practice 8123256302 Receives reassigned benefits from 8 practitioners
Practice locations: New Hyde Park, NY; Rockville Centre, NY; Oceanside, NY; Lynbrook, NY; Hempstead, NY; Harrison, NY

National Provider Directory

National Provider Directory

Locations

900 Northern Blvd
Ste 260
Great Neck, NY 11021
Phone (516) 773-7737

440 Mamaroneck Ave
Ste 400
Harrison, NY 10528
Phone (914) 231-8494

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1568898138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 BRUSH HOLLOW RD",
            "address_2": "FINANCE 5TH FLOOR",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115901740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 HEMPSTEAD AVE",
            "city": "LYNBROOK",
            "state": "NY",
            "postal_code": "115631605",
            "telephone_number": "516-593-3541",
            "fax_number": "516-599-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE - LIJ INTERNAL MEDICINE AT LYNBROOK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "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": "516-562-8182",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore - LIJ Medical Group South Shore Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Shore - LIJ Medical Group South Shore Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynbrook, 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.