Organization · Type 2 NPI

Long Island Jewish Medical Center

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Queens Village, NY

NPI number 1093723488 Active

Practice location

22022 Hillside Avenue
Queens Village, NY 11427-2020

Call (516) 876-6000 Map

Fax (516) 876-6600

Mailing address

972 Brush Hollow Rd, 5th Flooor Finance
Westbury, NY 11590-1740

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	7003004H (NY)

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

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NPI record

NPI: 1093723488
Entity type: Organization (Type 2)
Issued: Aug 3, 2006
Last updated: Nov 28, 2018
Status: Active
Subpart: Yes of Long Island Jewish Medical Center

Other names

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End Stage Renal Dialysis Facility · other name
End Stage Renal Dialysis Facility · other name

Authorized official

Mrs. Michele Lee Cusack
Senior Vice President & CFO
(516) 321-6058

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1093723488

Long Island Jewish Medical Center's National Provider Identifier is 1093723488, issued on Aug 3, 2006. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Queens Village, NY. The record was last updated on Nov 28, 2018.