Provider Demographics
NPI:1588823108
Name:STATEN ISLAND UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:STATEN ISLAND UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTY-MEYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:718-226-9004
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:EMPLOYEE HEALTH SERVICE
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-9004
Mailing Address - Fax:718-226-8201
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:EMPLOYEE HEALTH SERVICE
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9004
Practice Address - Fax:718-226-8201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH SHORE LONG ISLAND JEWISH HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335288-1282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital