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General NPI Number Information
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NPI Number | 1336206242
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Entity Type | Organization
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Legal Business Name | ST LUKES - ROOSEVELT HOSPITAL CENTER
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 780 8TH AVE SUITE 303
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City | NEW YORK
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State | NY
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Zip | 10036-7017
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Country | US
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Telephone | 212-641-4500
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Fax | 212-641-4510
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Provider Business Mailing Address
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Address Line | PO BOX 95000-2409
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City | PHILADELPHIA
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State | PA
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Zip | 19195-2409
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Country | US
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Telephone | 212-308-1112
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Fax | 212-308-1616
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARK GRAY
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Credential | M.D.
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Telephone | 212-308-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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