Provider Demographics
NPI:1265605752
Name:NORTH SHORE - LIJ RADIOLOGY SERVICES, PC
Entity type:Organization
Organization Name:NORTH SHORE - LIJ RADIOLOGY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-829-4414
Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5316
Mailing Address - Country:US
Mailing Address - Phone:516-829-4414
Mailing Address - Fax:516-829-7754
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5316
Practice Address - Country:US
Practice Address - Phone:516-829-4414
Practice Address - Fax:516-829-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYQPX1Medicare PIN