# NORTH SHORE-LIJ MEDICAL GROUP AT HUNTINGTON PC

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

## Provider details

- **NPI number:** 1174147979
- **Authorized official:** MRS. MICHELE L CUSACK (SENIOR VICE PRESIDENT & CFO)
- **Authorized official phone:** (516) 321-6058

## Contact information

- **Practice address:** 2001 MARCUS AVE STE S50, NEW HYDE PARK, NY 11042-1039
- **Practice address phone:** (516) 328-9800
- **Practice address fax:** (516) 328-9801
- **Mailing address:** 2001 MARCUS AVE STE S50, NEW HYDE PARK, NY 11042-1039
- **Mailing address phone:** (516) 328-9800
- **Mailing address fax:** (516) 328-9801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2020
- **Last updated:** 07/08/2022