1902029796 NPI number — LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH

Table of content: (NPI 1902029796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902029796 NPI number — LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONG ISLAND COMMUNITY HOSPITAL AT NYU LANGONE HEALTH
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:
CHEMICAL DEPENDENCY CTR EAST
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:
1902029796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HOSPITAL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-654-7100
Provider Business Mailing Address Fax Number:
516-333-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 MONTAUK HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIRLEY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11967-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-490-3040
Provider Business Practice Location Address Fax Number:
631-395-6340
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00245529 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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