NPIMap

Organization Active NPI

Long Island Community Hospital at NYU Langone Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shirley, NY
National Provider Identifier
1902029796
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH
Practice address
550 Montauk Highway
Shirley, NY 11967-2114
Phone
(631) 490-3040
Fax
(631) 395-6340
NPI assigned
Apr 10, 2007
Last updated
Mar 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Authorized official

Name
Marc J Adler
Title
Sr. VP & Chief of Hosp Operations
Phone
(516) 592-9098

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

550 Montauk Highway
Shirley, NY 11967-2114

Mailing address

101 Hospital Road
Patchogue, NY 11772-4870
Phone (631) 654-7100

Other identifiers 1

IdentifierTypeStateIssuer
00245529MedicaidNY

Other names 1

  • Chemical Dependency Ctr East Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2215391Long Island Community Hospital550 Montauk Highway, Shirley, NY 11967Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Part of
Brookhaven Emer Med Ass

Locations

100 Hospital Rd
Ste 121
East Patchogue, NY 11772
Phone (631) 654-7100

103 W Main St
Patchogue, NY 11772
Phone (631) 687-4188

55 Medford Ave
Patchogue, NY 11772
Phone (631) 569-8325

Practitioners & affiliated clinicians

Practitioners 110

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 110

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1902029796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 HOSPITAL ROAD",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117724870",
            "telephone_number": "631-654-7100",
            "fax_number": "516-333-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 MONTAUK HIGHWAY",
            "city": "SHIRLEY",
            "state": "NY",
            "postal_code": "119672114",
            "telephone_number": "631-490-3040",
            "fax_number": "631-395-6340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH",
        "enumeration_date": "2007-04-10",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "ADLER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. VP & CHIEF OF HOSP OPERATIONS",
        "authorized_official_telephone_number": "516-592-9098"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00245529",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chemical Dependency Ctr East",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shirley, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.