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Organization
ST LUKES ROOSEVELT COMMUNITY CARE
Active
Organization
ST LUKES ROOSEVELT COMMUNITY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALCOLM D REID (GROUP DIRECTOR)
(212) 523-7878
Entity
Organization
Contact information
Practice address
1000 10TH AVE, NEW YORK, NY 10019-1147
(212) 523-7878
Mailing address
407 AIRPORT EXECUTIVE PARK, NANUET, NY 10954-5288
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
213E00000X
Podiatrist
—
—
363L00000X
Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02195022
—
NY
Enumeration date
10/31/2007
Last updated
10/31/2007
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