Provider Demographics
NPI:1013184639
Name:ST. LUKE'S CORNWALL HOSPITAL
Entity Type:Organization
Organization Name:ST. LUKE'S CORNWALL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ATZROTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-561-4400
Mailing Address - Street 1:70 DUBOIS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4851
Mailing Address - Country:US
Mailing Address - Phone:845-561-4400
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3522000H261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
10014302OtherCDPHP
43910OtherMEDICARE GHI
04539OtherBENEFIT PLAN ADMIN
104575OtherMEDICAID WELLCARE
60966OtherLOCAL 445
60966OtherUS HEALTHCARE
IC8857OtherHEALTHNET
00156OtherBLUE CROSS
NY273863Medicaid
701715OtherMVP HEALTH PLAN
H04201OtherOXFORD HEALTH PLAN
10014302OtherCDPHP