Basic Information
| Provider Information | |||||||||
| NPI: | 1104982917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST LUKES ROOSEVELT HOSPITAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WATER ST | ||||||||
| Address2: | 24TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100384922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122563030 | ||||||||
| FaxNumber: | 2122563594 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 10TH AVE | ||||||||
| Address2: | ROOSEVELT DIVISION | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125234000 | ||||||||
| FaxNumber: | 2122563594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | BARRITT | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6466054217 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 273R00000X | 7002032H | NY | N | Hospital Units | Psychiatric Unit | 273Y00000X | 7002032H | NY | N | Hospital Units | Rehabilitation Unit | 276400000X | 7002032H | NY | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 341600000X | 7002032H | NY | N | Transportation Services | Ambulance | 282N00000X | 7002032H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 01650173 | 05 | NY | MEDICAID | 00354967 | 05 | NY | MEDICAID | 000559 | 01 | NY | BLUE CROSS | OTHER | 00239247 | 05 | NY | MEDICAID |