NPIMap

Organization Active NPI

Long Island Jewish Medical Center

Doing business as Opioid Treatment Program

  • Methadone Clinic
  • Glen Oaks, NY
National Provider Identifier
1740872365
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
LONG ISLAND JEWISH MEDICAL CENTER
Doing business as
Opioid Treatment Program
Practice address
7559 263Rd St
Glen Oaks, NY 11004-1150
Phone
(718) 470-8940
NPI assigned
Feb 4, 2021
Last updated
Jul 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X NU Primary

Addresses

Primary practice location

7559 263Rd St
Glen Oaks, NY 11004-1150

Mailing address

7559 263Rd St
Glen Oaks, NY 11004-1150
Phone (718) 470-8940

Other names 1

  • Opioid Treatment Program Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210330002406 NY Part A Provider - Other 2567375421 Practice locations: Glen Oaks, 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

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753747200000",
    "number": "1740872365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7559 263RD ST",
            "city": "GLEN OAKS",
            "state": "NY",
            "postal_code": "110041150",
            "telephone_number": "718-470-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7559 263RD ST",
            "city": "GLEN OAKS",
            "state": "NY",
            "postal_code": "110041150",
            "telephone_number": "718-470-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND JEWISH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Opioid Treatment Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Opioid Treatment Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Oaks, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; 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.