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General NPI Number Information
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NPI Number | 1477815520
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND UNIVERSITY HOSPITAL
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 227 KOCH BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5416
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Country | US
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Telephone | 917-655-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 227 KOCH BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5416
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Country | US
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Telephone | 917-655-6207
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Fax |
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Authorized Official
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Title or Position | PGY-1
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Name | OTAR DATAN
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Credential | MD
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Telephone | 917-655-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | NY
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