Request an itemized bill indicates a required field Note: The following Northwell facilities are not yet included for online itemized bill requests: Labs, GoHealth Urgent Care, Home Healthcare, Hospice Care, Mather Hospital, Northern Westchester Hospital, Peconic Bay Medical Center, Phelps Hospital, Rehab Services, and South Oaks Hospital. To request an itemized bill for any of these facilities or services, please refer to the phone number on the bill. Patient information First name Last name Facility name - Select -Cohen Children’s Medical CenterForest Hills HospitalGlen Cove HospitalHuntington HospitalLenox Hill HospitalLong Island Jewish Medical CenterNorth Shore University HospitalNorthwell Ambulance ServicesNorthwell Health Physician PartnersPlainview HospitalSouthside HospitalStaten Island University HospitalValley Stream HospitalZucker Hillside Hospital Account or invoice number Note: This can be found on your paper bill - include alpha characters, if applicable. Invoice number Note: This can be found under the “Billed Services” section on your bill Date of birth Date of service Your information Your first name Your last name Your relationship to patient - Select -SelfSpouseParent of minor childLegal guardianAttorneyPower of attorneyEstate executor Your email address Phone Itemized bill requests are sent to the Guarantor address saved in our records Please check this box if you are requesting to have an itemized bill sent to an address that is, or you think may be, different than what is saved in our records. By providing your email address, you agree to receive email communication from Northwell Health.