Provider Demographics
NPI:1063671352
Name:ST.LUKES-ROOSEVELT HOSPITAL CENTER
Entity Type:Organization
Organization Name:ST.LUKES-ROOSEVELT HOSPITAL CENTER
Other - Org Name:C/O OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-636-1122
Mailing Address - Street 1:1111 AMSTERDAM AVE
Mailing Address - Street 2:C/O OUTPATIENT PHARMACY 3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1716
Mailing Address - Country:US
Mailing Address - Phone:212-636-1122
Mailing Address - Fax:212-636-1123
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:C/O OUTPATIENT PHARMACY 3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-636-1122
Practice Address - Fax:212-636-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028893281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital