Provider Demographics
NPI:1407877137
Name:STATEN ISLAND UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:STATEN ISLAND UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-321-6058
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-4502
Mailing Address - Fax:718-226-4875
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-4502
Practice Address - Fax:718-226-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7004003H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NPC91662OtherELDERPLAN
ANC1049OtherOXFORD
000201/00201OtherBLUE CROSS BURN
001342OtherHORIZON
IC0093/IC0094OtherPHS
000412345697OtherHEALTHPLUS
13297OtherAETNA/USHEALTHCARE
962OtherANTHEM
A36976OtherOXFORD RADIOLOGY
000081OtherBLUE CROSS
000501301OtherAMERICHOICE
16297OtherGHI
00881OtherFIDELIS
0091401OtherGHI/OMH SUBSTANCE ABUSE
H03123OtherOXFORD
NY00244202Medicaid
2946OtherHEALTHFIRST
5000069OtherUNITED HEALTH
H03123OtherOXFORD