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DSH330043E SOUTH SHORE UNIVERSITY HOSPITAL (Active)
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Main Details
Name
SOUTH SHORE UNIVERSITY HOSPITAL
Subdivision Name
Brentwood Infusion - Pain Management
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330043E
Medicare Provider Number
330043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
2/1/2023
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 Rd
202
Bay Shore, NY 11706
Billing Address
South Shore University Hospital
2048 Sunrise Highway
Bay shore, NY 11706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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