Healthcare Provider Details

I. General information

NPI: 1063671352
Provider Name (Legal Business Name): ST.LUKES-ROOSEVELT HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE C/O OUTPATIENT PHARMACY 3RD FLOOR
NEW YORK NY
10025-1716
US

IV. Provider business mailing address

1111 AMSTERDAM AVE C/O OUTPATIENT PHARMACY 3RD FLOOR
NEW YORK NY
10025-1716
US

V. Phone/Fax

Practice location:
  • Phone: 212-636-1122
  • Fax: 212-636-1123
Mailing address:
  • Phone: 212-636-1122
  • Fax: 212-636-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number028893
License Number StateNY

VIII. Authorized Official

Name: RANDALL J NOVAK
Title or Position: PHARMACY SUPERVISOR
Credential:
Phone: 212-636-1122