# NORTH SHORE HEALTH SYSTEM MEDICAL FACULTY GROUP PRACTICE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003409061
- **Authorized official:** MRS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
- **Authorized official phone:** (516) 321-6058

## Contact information

- **Practice address:** 450 LAKEVILLE RD, NEW HYDE PARK, NY 11042-1118
- **Practice address phone:** (516) 734-8900
- **Practice address fax:** (516) 734-8934
- **Mailing address:** 450 LAKEVILLE RD, NEW HYDE PARK, NY 11042-1118
- **Mailing address phone:** (516) 734-8900
- **Mailing address fax:** (516) 734-8934

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | Yes |
| 207RH0003X | Hematology & Oncology Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2021
- **Last updated:** 02/19/2021