NPIMap

Organization Active NPI

North Shore Lij Medical Group at North Nassau, PC

  • Cardiovascular Disease Physician
  • Glen Cove, NY
National Provider Identifier
1700175270
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
NORTH SHORE LIJ MEDICAL GROUP AT NORTH NASSAU, PC
Practice address
70 Glen St
Suite 200
Glen Cove, NY 11542-2855
Phone
(516) 484-7893
NPI assigned
Apr 5, 2011
Last updated
Jul 26, 2022By the provider in NPPES
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) 465-8182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary

Addresses

Primary practice location

70 Glen St
Suite 200
Glen Cove, NY 11542-2855

Mailing address

972 Brush Hollow Rd
Finance 5TH Floor
Westbury, NY 11590-1740
Phone (516) 876-6065

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110602000255 NY Part B Supplier - Clinic/Group Practice 7618154550 Receives reassigned benefits from 60 practitioners
Practice locations: Syosset, NY; Rego Park, NY; New York, NY; New Hyde Park, NY; Melville, NY; Great Neck, NY; Manhasset, NY; Huntington, NY…

National Provider Directory

National Provider Directory

Locations

17660 Union Tpke
Ste 350
Fresh Meadows, NY 11366
Phone (718) 521-6200

8015 164th St
Jamaica, NY 11432
Phone (718) 380-6010

225 E 64th St
Ste Bll
New York, NY 10065
Phone (212) 860-2600

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1700175270",
    "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",
            "telephone_number": "516-876-6065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 GLEN ST",
            "address_2": "SUITE 200",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422855",
            "telephone_number": "516-484-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE LIJ MEDICAL GROUP AT NORTH NASSAU, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "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": "516-465-8182",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Cove, 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.