Provider Demographics
NPI:1144494311
Name:NORH SHORE LIJ- ZUCKER HILLSIDE HOSPITAL
Entity type:Organization
Organization Name:NORH SHORE LIJ- ZUCKER HILLSIDE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,NPP,CPNP
Authorized Official - Phone:718-470-3500
Mailing Address - Street 1:52 WINTHROP ST
Mailing Address - Street 2:NEW HYDE PARK
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3145
Mailing Address - Country:US
Mailing Address - Phone:516-352-8197
Mailing Address - Fax:
Practice Address - Street 1:444 COMMUNITY DR
Practice Address - Street 2:MANHASSET
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3820
Practice Address - Country:US
Practice Address - Phone:516-993-4724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400807261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health