Organization
SOUTHSIDE FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE L CUSACK (EXECUTIVE VICE PRESIDENT & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
1220 HICKSVILLE RD, SEAFORD, NY 11783-1604
(516) 266-3456
(516) 266-3490
Mailing address
2000 MARCUS AVE, NEW HYDE PARK, NY 11042-1069
(516) 266-3456
(516) 266-3490
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
01/06/2026
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