Provider Demographics
NPI:1780022772
Name:NORTH SHORE LIJ OB GYN AT GARDEN CITY PC
Entity type:Organization
Organization Name:NORTH SHORE LIJ OB GYN AT GARDEN CITY PC
Other - Org Name:<UNAVAIL>
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:516-465-8162
Mailing Address - Street 1:972 BRUSH HOLLOW RD
Mailing Address - Street 2:FINANCE 5TH FLOOR
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1740
Mailing Address - Country:US
Mailing Address - Phone:516-876-6065
Mailing Address - Fax:
Practice Address - Street 1:877 STEWART AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-622-2072
Practice Address - Fax:516-222-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty