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DSH330160K STATEN ISLAND UNIVERSITY HOSPITAL (Active)
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Main Details
Name
STATEN ISLAND UNIVERSITY HOSPITAL
Subdivision Name
School Health Center at New Dorp
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330160K
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
465 New Dorp Lane
Room S117
Staten Island, NY 10306
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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