Provider Demographics
NPI:1164846317
Name:STATEN ISLAND UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:STATEN ISLAND UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUNGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:718-226-6400
Mailing Address - Street 1:14 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1807
Mailing Address - Country:US
Mailing Address - Phone:917-435-0927
Mailing Address - Fax:718-948-2774
Practice Address - Street 1:14 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1807
Practice Address - Country:US
Practice Address - Phone:917-435-0927
Practice Address - Fax:718-948-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337728282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital