Healthcare Provider Details

I. General information

NPI: 1679952691
Provider Name (Legal Business Name): ST.LUKE'S ROOSEVELT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 AMSTERDAM AVE
NEW YORK NY
10025-1716
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: 212-256-3296
  • Fax: 212-256-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHEAL BRUNO
Title or Position: SENIOR VICE PRESIDENT / CFO
Credential:
Phone: 212-523-7140