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DSH330195J LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Pediatric & Adolescent Medicine Clinic / Adolescent Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195J
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
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
410 Lakeville Rd
Suite 108
108
New Hyde Park, NY 11040
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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