Affiliation Verification Lookup Portal
Providers for Northwell Health - Global Mode
Glen Cove Hospital
Huntington Hospital
Lenox Hill Hospital
Long Island Jewish Forest Hills
Long Island Jewish Medical Center
Long Island Jewish Valley Stream
Mather Hospital
North Shore University Hospital
North Shore University Hospital Syosset
Northern Westchester Hospital
Northwell Health Family Health Center at Huntington
Northwell Health Stern Family Center for Rehabilitation
Peconic Bay Medical Center
Phelps Hospital
Plainview Hospital
South Oaks Hospital (LI Home)
South Shore University Hospital
Staten Island University Hospital
Provider Last Name
Last name is required.
Provider First Name
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Provider Birthdate
Birthdate is required.
Please provide a valid Date.
Required Information
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Requester Name
Name is required.
Requester Title
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Requester Organization
Organization is required.
Requester Address
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Requester City, State, Zip
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Requester Phone
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Requester Fax
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Requester Email
Email is required.
I agree and acknowledge that I possess a signed release and immunity statement signed by the practitioner for which I am obtaining hospital verification information. Such signed release and immunity holds harmless and indemnifies Northwell Health and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such Northwell Health and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the practitioner's hospital affiliation with Northwell Health.
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Please Enter the Following Information:
Facility
Provider Last Name
Provider First Name
Provider Birthdate
Requester Name
Requester Title
Requester Organization
Requester Address
Requester City, State, Zip
Requester Phone
Requester Fax
Requester Email