Provider Demographics
NPI:1811368368
Name:THE ST. LUKES ROOSEVELT HOSPITAL CENTER
Entity Type:Organization
Organization Name:THE ST. LUKES ROOSEVELT HOSPITAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHYRN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-256-3001
Mailing Address - Street 1:150 E 42ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 W 114TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1796
Practice Address - Country:US
Practice Address - Phone:212-256-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI HEALTH HOME SERVING CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-09
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002032H251B00000X, 273R00000X, 273Y00000X, 276400000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251B00000XAgenciesCase Management
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit