Provider Demographics
NPI:1174926406
Name:LONG ISLAND JEWISH MEDICAL CENTER
Entity type:Organization
Organization Name:LONG ISLAND JEWISH MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP, CHIEF EXPENSE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-470-8486
Mailing Address - Street 1:1983 MARCUS AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:718-470-8486
Mailing Address - Fax:718-470-5508
Practice Address - Street 1:270-05 76TH AVE
Practice Address - Street 2:ATTN: VIVO HEALTH PHARMACY AT LIJ
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-8486
Practice Address - Fax:718-470-5508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONG ISLAND JEWISH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-01
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
NY0329273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04133506Medicaid
5811799OtherNABP
NY04133506Medicaid