1821438656 NPI number — NORTH SHORE LIJ INTERNAL MEDICINE AT NEW HYDE PARK PC

Table of content: LAURIE DAVIS (NPI 1467872861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821438656 NPI number — NORTH SHORE LIJ INTERNAL MEDICINE AT NEW HYDE PARK PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE LIJ INTERNAL MEDICINE AT NEW HYDE PARK PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH SHORE - LIJ MEDICAL GROUP AT NASSAU QUEENS PULMONARY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821438656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
972 BRUSH HOLLOW RD
Provider Second Line Business Mailing Address:
FINANCE 5TH FLOOR
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590-1740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-876-6065
Provider Business Mailing Address Fax Number:
516-876-6600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 NEW HYDE PARK RD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-326-0707
Provider Business Practice Location Address Fax Number:
516-326-1101
Provider Enumeration Date:
06/25/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUSAK
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
516-465-8162

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)