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DSH330195CB LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Queens Cancer Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195CB
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2024
Participating Start Date
10/1/2024
Participating Approval Date
8/16/2024
Last Recertification Date
Contacts
Authorizing Official
Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058
Primary Contact
Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720
Addresses
Street Address
95-25 Queens Blvd
Suite 601
Rego Park, NY 11374
Billing Address
LONG ISLAND JEWISH MEDICAL CENTER
270-05 76th Ave
New Hyde Park, NY 11040
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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