NPIMap

Organization Active NPI

North Shore - Lij Cardiology at Deer Park PC

Doing business as North Shore - LIJ Medical Group / Long Island Cardiovascular

  • Cardiovascular Disease Physician
  • Deer Park, NY
National Provider Identifier
1972941953
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 CARDIOLOGY AT DEER PARK PC
Doing business as
North Shore - LIJ Medical Group / Long Island Cardiovascular
Practice address
1630 Deer Park Ave
Deer Park, NY 11729-5210
Phone
(631) 242-6166
Fax
(631) 242-0728
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
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X Primary
Nuclear Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207UN0901X

Addresses

Primary practice location

1630 Deer Park Ave
Deer Park, NY 11729-5210

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 / Long Island Cardiovascular Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140708001692 NY Part B Supplier - Clinic/Group Practice 4486879418 Receives reassigned benefits from 10 practitioners
Practice locations: Bay Shore, NY; Babylon, NY; West Islip, NY; Deer Park, NY; Riverhead, NY

National Provider Directory

National Provider Directory

Locations

1630 Deer Park Ave
Deer Park, NY 11729
Phone (631) 242-6166

972 Brush Hollow Rd
Fl 5
Westbury, NY 11590
Phone (516) 876-6065

Practitioners & affiliated clinicians

Practitioners 10

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.

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": "1972941953",
    "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": "1630 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295210",
            "telephone_number": "631-242-6166",
            "fax_number": "631-242-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE - LIJ CARDIOLOGY AT DEER PARK 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": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore - LIJ Medical Group / Long Island Cardiovascular",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Shore - LIJ Medical Group / Long Island Cardiovascular",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deer Park, 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.