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DSH330160B STATEN ISLAND UNIVERSITY HOSPITAL (Active)
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Main Details
Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
Canarsie Chemical Dependency Treatment Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330160B
Medicare Provider Number
330160
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2013
Participating Start Date
5/2/2013
Participating Approval Date
5/2/2013
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
567 East 105th Street
Brooklyn, NY 11218
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/29/13-Email sent to request info. If I do not hear by COB tomorrow, I will delete. 4/24/13-email sent to request new trial balance.
04/29/2013
4/24/13-email sent to request new trial balance.
04/24/2013
June 2025
June 2025
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