Healthcare Provider Details

I. General information

NPI: 1104982917
Provider Name (Legal Business Name): ST LUKES ROOSEVELT HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE ROOSEVELT DIVISION
NEW YORK NY
10019
US

IV. Provider business mailing address

160 WATER ST 24TH FLOOR
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-4000
  • Fax: 212-256-3594
Mailing address:
  • Phone: 212-256-3030
  • Fax: 212-256-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number7002032H
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number7002032H
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number7002032H
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number7002032H
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number7002032H
License Number StateNY

VIII. Authorized Official

Name: MR. KENNETH BARRITT
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 646-605-4217