Provider Demographics
NPI:1942524178
Name:SLRHC FACULTY PRACTICE
Entity Type:Organization
Organization Name:SLRHC FACULTY PRACTICE
Other - Org Name:ST. LUKE'S MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-315-0144
Mailing Address - Street 1:1790 BROADWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1412
Mailing Address - Country:US
Mailing Address - Phone:212-315-0144
Mailing Address - Fax:212-315-0188
Practice Address - Street 1:2771 FREDERICK DOUGLASS BOULEVARD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039
Practice Address - Country:US
Practice Address - Phone:212-690-0303
Practice Address - Fax:212-504-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty