Basic Information
| Provider Information | |||||||||
| NPI: | 1679952691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST.LUKE'S ROOSEVELT HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WATER ST | ||||||||
| Address2: | 24TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100384922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122563296 | ||||||||
| FaxNumber: | 2122563594 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 AMSTERDAM AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100251716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125234000 | ||||||||
| FaxNumber: | 2122563594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2015 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRUNO | ||||||||
| AuthorizedOfficialFirstName: | MICHEAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT / CFO | ||||||||
| AuthorizedOfficialTelephone: | 2125237140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. LUKE'S ROOSEVELT HOSPTIAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 3416L0300X | 01 | NY | TAXONOMY | OTHER |