North Shore - Lij Medical Group at Syosset PC
Organization Active NPI Cardiovascular Disease Physician · Syosset, NY
NPI 1831494061 · NPPES record last updated Jul 26, 2022
Key facts
- NPI
- 1831494061
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- NORTH SHORE - LIJ MEDICAL GROUP AT SYOSSET PC
- Practice address
- 8 Greenfield Rd
Syosset, NY 11791-4831 - Phone
- (516) 465-8162
- NPI assigned
- Jan 19, 2011
- Organization subpart
- No
Authorized official
- Name
- Mrs. Michele Cusak
- Title
- Cfo
- Phone
- (516) 465-8182
Practitioners 12
-
Alexandra Perrone, F.N.P.
-
Jason Raymond Boglioli, M.D.
-
Paul C Moulinie, MD
-
Elisa Stickelman, ANP
-
Brian C Strizik, MD
-
Anil George Mathew, M.D.
-
Alex Vidal, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110426000517 | NY | Part B Supplier - Clinic/Group Practice | 2961687504 |
Receives reassigned benefits from 9 practitioners Practice locations: Woodbury, NY; Syosset, NY; Huntington Station, NY; Smithtown, NY; Northport, NY; Huntington, NY; Plainview, NY |
National Provider Directory
Locations
721 Fort Salonga Rd
Northport, NY 11768
Phone (631) 261-0444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes |
Addresses
Primary practice location
8 Greenfield Rd
Syosset, NY 11791-4831
Mailing address
600 Community Dr
Manhasset, NY 11030-3802
NPI Registry JSON
{
"created_epoch": "1295395200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658793600000",
"number": "1831494061",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8 GREENFIELD RD",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117914831",
"telephone_number": "516-465-8162"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NORTH SHORE - LIJ MEDICAL GROUP AT SYOSSET PC",
"organizational_subpart": "NO",
"enumeration_date": "2011-01-19",
"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": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syosset, NY
- Patrick Westbrook Nolan
- Lisa S. Noonan
- Nadege Normil-Malcolm
- North Coast Psychological Services, PLLC
- North Island Ophthalmology PC
- North Shore Counseling LCSW PC
- North Shore Diagnostics
- North Shore Lij
- North Shore Speech-Language Pathology, P.C
- North Shore University Hospital
All providers in Syosset, NY · Cardiovascular Disease Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.