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DSH330043B SOUTH SHORE UNIVERSITY HOSPITAL (Active)
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Main Details
Name
SOUTH SHORE UNIVERSITY HOSPITAL
Subdivision Name
Pain Management
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330043B
Medicare Provider Number
330043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/11/2017
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
39 Brentwood Road
202
Bay Shore, NY 11706
Billing Address
South Shore University Hospital
301 East Main Street
Bay Shore, NY 11706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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