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DSH330195AR LONG ISLAND JEWISH MEDICAL CENTER (Active)
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Main Details
Name
LONG ISLAND JEWISH MEDICAL CENTER
Subdivision Name
Northwell Health Imaging at Bay Shore - Radioisotope
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH330195AR
Medicare Provider Number
330195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/25/2017
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
440 East Main Street
Bay Shore, NY 11706
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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