# NORTH SHORE - LIJ HEALTH SYSTEM

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

## Provider details

- **NPI number:** 1295852192
- **Authorized official:** MR. JUSTIN ETTINGER MSPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (516) 627-8470

## Contact information

- **Practice address:** 1554 NORTHERN BLVD, PM&R, MANHASSET, NY 11030-3006
- **Practice address phone:** (516) 627-8670
- **Mailing address:** 3 CORNWALL LN, APT A1J, CARLE PLACE, NY 11514-1086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | 026037 | NY | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 08/22/2020