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DSH330160D STATEN ISLAND UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
Coney Island Multi Service Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330160D
Medicare Provider Number
330160
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2013
Participating Start Date
5/2/2013
Participating Approval Date
5/2/2013
Last Recertification Date
8/29/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Staten Island University Hospital
Brahim Ardolic, Executive Director
(718) 226-9761
Primary Contact
Staten Island University Hospital
John Peana, Director of Pharmacy
(718) 226-8870
Addresses
Street Address
425-427 Coney Island Avenue
Brooklyn, NY 11218
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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