MEDICARE: ST. LUKE'S ROOSEVELT HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	284300000X	Special Hospital		NY
2	282N00000X	General Acute Care Hospital		NY

General Provider Information

NPI Number	:	1215240148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKE'S ROOSEVELT HOSPITAL

Provider Business Mailing Address
First Line	:	319 E 50TH ST
Second Line	:	APARTMENT 9E
City	:	NEW YORK
State	:	NY
Zip	:	10022-7936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	319 E 50TH ST
Second Line	:	APARTMENT 9E
City	:	NEW YORK
State	:	NY
Zip	:	10022-7936
Country	:	US
Telephone Number	:	973-255-9819
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT
Name	:	DR. BRIAN WOSNITZER
Credential	:	M.D.
Telephone Number	:	973-255-9819

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	07/21/2022

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