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General NPI Number Information
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NPI Number | 1679221980
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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 | 03/15/2022
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone | 646-605-6004
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 AMSTERDAM AVE 10TH FLOOR CLARK BUILDING, SUITE 8-1003
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DENIS DONEGAN
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Credential |
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Telephone | 646-605-4217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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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 | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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