Provider Demographics
NPI:1548208127
Name:NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Entity Type:Organization
Organization Name:NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Other - Org Name:GOUVERNEUR HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARJI
Authorized Official - Middle Name:
Authorized Official - Last Name:KARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-458-3481
Mailing Address - Street 1:50 WATER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-6010
Mailing Address - Country:US
Mailing Address - Phone:646-458-3481
Mailing Address - Fax:646-458-3434
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:MEDICAL STAFF OFFICE R-1249
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7614
Practice Address - Fax:212-238-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002103R261Q00000X
3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243352Medicaid
NY009748OtherBLUE CROSS
W20771Medicare ID - Type UnspecifiedRAD
W20801Medicare ID - Type UnspecifiedRHB
NY009748OtherBLUE CROSS
W20741Medicare ID - Type UnspecifiedPSY
W20751Medicare ID - Type UnspecifiedOPT
W20781Medicare ID - Type UnspecifiedSUR
NYW20791Medicare ID - Type UnspecifiedDENTAL
W20811Medicare ID - Type UnspecifiedMED
NY00243352Medicaid
W20761Medicare ID - Type UnspecifiedPED