Provider Demographics
NPI:1225765621
Name:NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Entity Type:Organization
Organization Name:NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Other - Org Name:ROOSEVELT COMMUNITY HEALTH CENTER OF EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:LUCHY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-238-7815
Mailing Address - Street 1:3750 72ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6143
Mailing Address - Country:US
Mailing Address - Phone:466-615-7800
Mailing Address - Fax:466-615-7890
Practice Address - Street 1:3750 72ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6143
Practice Address - Country:US
Practice Address - Phone:212-238-7815
Practice Address - Fax:212-238-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center