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DSH330195AP LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Far Rockaway Treatment Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195AP
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/8/2016
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
1600 Central Avenue
Floor 2
Far Rockaway, NY 11691
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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