Organization
SOUTHSIDE FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORP
Active
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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