Provider Demographics
NPI:1124295746
Name:ST LUKES CORNWALL HOSPITAL
Entity type:Organization
Organization Name:ST LUKES CORNWALL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ATZROTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-561-4400
Mailing Address - Street 1:70 DUBOIS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4851
Mailing Address - Country:US
Mailing Address - Phone:845-561-4400
Mailing Address - Fax:
Practice Address - Street 1:70 DUBOIS ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4851
Practice Address - Country:US
Practice Address - Phone:845-561-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352200H273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
104575OtherMEDICAID WELLCARE
IC8857OtherHEALTHNET
H04201OtherOXFORD HEALTH PLAN
04539OtherBENEFIT PLAN ADMIN
60966OtherUS HEALTHCARE
701715OtherMVP HEALTH PLAN
10014302OtherCDPHP
NY273863Medicaid
00156OtherBLUE CROSS
43910OtherMEDICARE GHI
60966OtherLOCAL 445
43910OtherMEDICARE GHI