Healthcare Provider Details

I. General information

NPI: 1225062193
Provider Name (Legal Business Name): STATEN ISLAND UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-4502
  • Fax: 718-226-4875
Mailing address:
  • Phone: 718-226-4502
  • Fax: 718-226-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number7004003H
License Number StateNY

VIII. Authorized Official

Name: MS. MICHELE CUSACK
Title or Position: SVP AND CFO
Credential:
Phone: 516-321-6058