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General NPI Number Information
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NPI Number | 1811293301
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Entity Type | Organization
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Legal Business Name | OBGYN ASSOCIATES OF ST LUKES ROOSEVELT HOSPITAL
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 1000 10TH AVE
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City | NEW YORK
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State | NY
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Zip | 10019-1147
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Country | US
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Telephone | 212-523-3348
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Fax | 212-523-8066
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Provider Business Mailing Address
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Address Line | 1157 E 22ND ST
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City | BROOKLYN
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State | NY
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Zip | 11210-3619
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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 | PHYSICIAN ASSISTANT
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Name | MRS. SHIRA MATALON-GRAZI
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Credential | RPA-C
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Telephone | 917-270-5748
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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 | 23 014437
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License Number State | NY
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