1407877137 NPI number — STATEN ISLAND UNIVERSITY HOSPITAL

Table of content: (NPI 1407877137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407877137 NPI number — STATEN ISLAND UNIVERSITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATEN ISLAND UNIVERSITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407877137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 SEAVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10305-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-226-4502
Provider Business Mailing Address Fax Number:
718-226-4875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 SEAVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-4502
Provider Business Practice Location Address Fax Number:
718-226-4875
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUSACK
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR VICE PRESIDENT AND CFO
Authorized Official Telephone Number:
516-321-6058

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  7004003H , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPC91662 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC1049 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000201/00201 . This is a "BLUE CROSS BURN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001342 . This is a "HORIZON" identifier . This identifiers is of the category "OTHER".
  • Identifier: IC0093/IC0094 . This is a "PHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000412345697 . This is a "HEALTHPLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13297 . This is a "AETNA/USHEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 962 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: A36976 . This is a "OXFORD RADIOLOGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000081 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000501301 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16297 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00881 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0091401 . This is a "GHI/OMH SUBSTANCE ABUSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H03123 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00244202 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2946 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5000069 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".




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