Provider Demographics
NPI:1699798934
Name:BETH ISRAEL MEDICAL CENTER
Entity type:Organization
Organization Name:BETH ISRAEL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-420-2124
Mailing Address - Street 1:1900 HEMPSTEAD TURNPIKE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1724
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:516-794-8165
Practice Address - Street 1:10 NATHAN D PERLMAN PLACE
Practice Address - Street 2:
Practice Address - City:SUITE 12S34
Practice Address - State:NY
Practice Address - Zip Code:10003-3851
Practice Address - Country:US
Practice Address - Phone:212-420-2124
Practice Address - Fax:212-420-3449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02985073Medicaid
NY33D0667624OtherCLIA
NY33D0667624OtherCLIA