Organization
NORTH SHORE - LIJ ANESTHESIOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE L CUSACK (SENIOR VP & CFO)
(516) 321-6058
Entity
Organization
Contact information
Practice address
480 BEDFORD RD BLDG B, CHAPPAQUA, NY 10514-1715
(914) 666-8866
(914) 666-6777
Mailing address
PO BOX 417998, BOSTON, MA 02241-7998
(914) 666-8866
(914) 666-6777
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4690557
—
NY
01
—
A100160302
GROUP MEDICARE PTAN
NY
Enumeration date
08/10/2016
Last updated
07/08/2022
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