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DSH330160L STATEN ISLAND UNIVERSITY HOSPITAL (Active)
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Main Details
Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
Medical Arts Pavilion-Radiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330160L
Medicare Provider Number
330160
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2013
Participating Start Date
5/16/2013
Participating Approval Date
5/16/2013
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
256 Mason Avenue
Staten Island, NY 10305
Billing Address
Staten Island University
475 Seaview Avenue
Staten Island, NY 10305
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/1/13-Trial Balance says this is on line 43 of CR. Not eligible.
05/01/2013
June 2025
June 2025
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