Provider Demographics
NPI:1609476357
Name:ST. LUKES ROOSEVELT HOSPITAL CENTER
Entity Type:Organization
Organization Name:ST. LUKES ROOSEVELT HOSPITAL CENTER
Other - Org Name:OTP
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:LUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURAMELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-523-5639
Mailing Address - Street 1:160 WATER ST FL 24
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-256-3296
Mailing Address - Fax:
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-256-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI ST LUKES HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder