Provider Demographics
NPI:1104982917
Name:ST LUKES ROOSEVELT HOSPITAL CENTER
Entity type:Organization
Organization Name:ST LUKES ROOSEVELT HOSPITAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-605-4217
Mailing Address - Street 1:160 WATER ST
Mailing Address - Street 2:24TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-256-3030
Mailing Address - Fax:212-256-3594
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:ROOSEVELT DIVISION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-523-4000
Practice Address - Fax:212-256-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NY7002032H273R00000X, 273Y00000X, 276400000X, 341600000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No251B00000XAgenciesCase Management
No273R00000XHospital UnitsPsychiatric Unit
No273Y00000XHospital UnitsRehabilitation Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01650173Medicaid
NY00354967Medicaid
NY000559OtherBLUE CROSS
NY00239247Medicaid
330046Medicare ID - Type Unspecified
NY01650173Medicaid
33S046Medicare ID - Type Unspecified