Provider Demographics
NPI:1063562551
Name:ST LUKES ROOSEVELT HOSPITAL CENTER
Entity type:Organization
Organization Name:ST LUKES ROOSEVELT HOSPITAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHMIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-604-1975
Mailing Address - Street 1:203 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7762
Mailing Address - Country:US
Mailing Address - Phone:212-604-1970
Mailing Address - Fax:212-604-1971
Practice Address - Street 1:203 W 12TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7762
Practice Address - Country:US
Practice Address - Phone:212-604-1970
Practice Address - Fax:212-604-1971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336S0011X
NY0301983336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3332385OtherNCPDP PROVIDER IDENTIFICATION NUMBER