Provider Demographics
NPI:1811293301
Name:OBGYN ASSOCIATES OF ST LUKES ROOSEVELT HOSPITAL
Entity type:Organization
Organization Name:OBGYN ASSOCIATES OF ST LUKES ROOSEVELT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATALON-GRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:RPA-C
Authorized Official - Phone:917-270-5748
Mailing Address - Street 1:1157 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3619
Mailing Address - Country:US
Mailing Address - Phone:
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:212-523-3348
Practice Address - Fax:212-523-8066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTINUUM HEALTH PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 014437282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital