Provider Demographics
NPI:1215911946
Name:NEW YORK GRACIE SQUARE HOSPITAL INC
Entity type:Organization
Organization Name:NEW YORK GRACIE SQUARE HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-434-5300
Mailing Address - Street 1:420 E 76TH ST
Mailing Address - Street 2:ATTN: JEROME B VOGL - I.S. DEPARTMENT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3104
Mailing Address - Country:US
Mailing Address - Phone:212-434-5532
Mailing Address - Fax:212-434-5479
Practice Address - Street 1:420 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3104
Practice Address - Country:US
Practice Address - Phone:212-434-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA713070283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00273047Medicaid
334048Medicare ID - Type Unspecified
W33921Medicare PIN