North Shore-LIJ Health System has expanded its footprint in New York City by entering into an affiliation with Maimonides Medical Center in Brooklyn.

The Maimonides board voted unanimously Tuesday night to approve the affiliation, which will mean "tens of millions" of dollars in renovations and outpatient expansion for the 711-bed hospital, according to North Shore-LIJ spokesman Terry Lynam.

Eventually North Shore-LIJ and Maimonides will fully integrate, "in a phased approach that will begin immediately," the two jointly announced Wednesday. In the meantime, both institutions maintain their independence and separate governance structures. Lynam said there was no specific time frame for full integration.

The affiliation allows the two to work together now rather than wait for the state approvals required for full integration, Lynam said. "The desire was to move quickly," he said.

For North Shore-LIJ, the relationship means it has a hospital or hospitals in every borough except the Bronx.

"They are the premier health care provider in Brooklyn," Lynam said. "This is North Shore-LIJ's first foray into Brooklyn. By partnering with Maimonides and helping them, and investing in the potential of clinical services, we're going to be positioning them for long-term success."

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For Maimonides, the relationship ensures long-term financial stability with a partner committed to community care, hospital spokeswoman Eileen Tynion said. The hospital reported a $3.7 million loss for the first six months of this year.

"We're not in deep financial trouble, but we know we will be if we don't have a partner," Tynion said.

Maimonides, which had signed a memorandum of understanding with the health system in February, also shares North Shore-LIJ's vision to provide a high level of care in the community, she said.

"We feel strongly that folks in Brooklyn need tertiary [specialist] care in Brooklyn," she said. The hospital had looked into affiliations with Manhattan-based health systems, but they were not as committed to ensuring that patients wouldn't have to travel to get their specialty care, she said.

North Shore-LIJ, the country's 14th largest health care system, owns 19 hospitals. In the city that includes Lenox Hill Hospital in Manhattan, Staten Island University Hospital, and, in Queens, Forest Hills Hospital, Long Island Jewish Medical Center, Cohen Children's Medical Center and Zucker Hillside Hospital, a behavioral health center.