Basic Information
| Provider Information | |||||||||
| NPI: | 1992013676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE LONG ISLAND JEWISH MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7576 184TH ST | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113661715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186746456 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27005 76TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110401402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2010 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | ELNATANOVA | ||||||||
| AuthorizedOfficialFirstName: | MILENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 7184707030 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH SHORE | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 010047 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.