Provider Demographics
NPI:1215038096
Name:ST. BARNABAS HOSPITAL
Entity Type:Organization
Organization Name:ST. BARNABAS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SR. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GORLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-960-3867
Mailing Address - Street 1:4422 3RD AVENUE
Mailing Address - Street 2:ST BARNABAS HOSPITAL-MENTAL INPATIENT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2545
Mailing Address - Country:US
Mailing Address - Phone:718-960-3867
Mailing Address - Fax:718-960-6465
Practice Address - Street 1:4422 THIRD AVENUE
Practice Address - Street 2:ST BARNABAS HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-3867
Practice Address - Fax:718-960-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000014H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70000HOtherSBH NYS OPERATING CERT #
NY00243361Medicaid
NY1176OtherSBH PFI #
NY00243361Medicaid