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DSH330160BC STATEN ISLAND UNIVERSITY HOSPITAL (Active)
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Main Details
Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
STATEN ISLAND UNIVERSITY HOSPITAL - Diabetes Wellness Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330160BC
Medicare Provider Number
330160
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/10/2024
Participating Start Date
10/1/2024
Participating Approval Date
8/5/2024
Last Recertification Date
Contacts
Authorizing Official
Northwell Health
Michele L Cusack, Executive Vice President
(516) 321-6058
Primary Contact
Northwell
Onisis Stefas, VP of Pharmacy Operations
(516) 719-5720
Addresses
Street Address
440 SEAVIEW AVENUE
STATEN ISLAND, NY 10305-3401
Billing Address
Staten Island University Hospital
475 Seaview Ave
Staten Island, NY 10305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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