Provider Demographics
NPI:1417019217
Name:LONG ISLAND COLLEGE HOSPITAL
Entity type:Organization
Organization Name:LONG ISLAND COLLEGE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-523-7140
Mailing Address - Street 1:160 WATER STREET
Mailing Address - Street 2:ROOM 2329
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-256-3027
Mailing Address - Fax:212-256-3595
Practice Address - Street 1:339 HICKS STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-780-1000
Practice Address - Fax:212-256-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001017H273R00000X, 282N00000X, 273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
No273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243678Medicaid
NY000060OtherBLUE CROSS
33T152Medicare ID - Type Unspecified
NY000060OtherBLUE CROSS
330152Medicare ID - Type Unspecified