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DSH330160 STATEN ISLAND UNIVERSITY HOSPITAL (Active)
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Main Details
Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330160
Medicare Provider Number
330160
Additional Details
Current Program Status
Active
Registration Date
4/21/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/21/2008
Last Recertification Date
8/19/2024
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
475 SEAVIEW AVE.
STATEN ISLAND, NY 10305
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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