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DSH330195L LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Long Island Jewish Medical Center LIJ Satellite Dialysis Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195L
Medicare Provider Number
330195
Outpatient Facility Provider Number
333503
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
220-22 Hillside Avenue
Queens Village, NY 11427
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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