NPIMap

Organization Active NPI

North Shore Lij OB GYN at Garden City PC

  • Obstetrics & Gynecology Physician
  • Garden City, NY
National Provider Identifier
1780022772
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
NORTH SHORE LIJ OB GYN AT GARDEN CITY PC
Practice address
877 Stewart Ave
Suite 7
Garden City, NY 11530-4803
Phone
(516) 622-2072
Fax
(516) 222-2854
NPI assigned
Jun 12, 2013
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X

Addresses

Primary practice location

877 Stewart Ave
Suite 7
Garden City, NY 11530-4803

Mailing address

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

Other names 1

  • North Shore LIJ Medical Group all about Women Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130905000207 NY Part B Supplier - Clinic/Group Practice 5294978516 Receives reassigned benefits from 17 practitioners
Practice locations: Garden City, NY; Lynbrook, NY; Manhasset, NY; Mineola, NY

National Provider Directory

National Provider Directory

Locations

444 Merrick Rd
Ste 106B
Lynbrook, NY 11563
Phone (516) 222-0722

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1370995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1780022772",
    "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": "877 STEWART AVE",
            "address_2": "SUITE 7",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115304803",
            "telephone_number": "516-622-2072",
            "fax_number": "516-222-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE LIJ OB GYN AT GARDEN CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-12",
        "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": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore LIJ Medical Group all about Women",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Shore LIJ Medical Group all about Women",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden City, 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.