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DSH330195 LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195
Medicare Provider Number
330195
Additional Details
Current Program Status
Active
Registration Date
6/5/2007
Participating Start Date
7/1/2007
Participating Approval Date
6/6/2007
Last Recertification Date
8/19/2024
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
270-05 76TH AVENUE
NEW HYDE PARK, NY 11040
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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