1174508360 NPI number — ST LUKES ROOSEVELT HOSPITAL CENTER

Table of content: (NPI 1174508360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174508360 NPI number — ST LUKES ROOSEVELT HOSPITAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES ROOSEVELT HOSPITAL CENTER
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:
PERINATAL ASSOCIATES OF SLR
Provider Other Organization Name Type Code:
3
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:
1174508360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95000-4930
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19195-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-338-5300
Provider Business Mailing Address Fax Number:
516-333-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PRIMARY 1000 10TH AVENUE, STE 11A-61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-523-8110
Provider Business Practice Location Address Fax Number:
212-523-3472
Provider Enumeration Date:
12/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SINGERMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
212-523-3452

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01570034 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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