Basic Information
| Provider Information | |||||||||
| NPI: | 1053556159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STATEN ISLAND UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 DONGAN HILLS AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103052239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186689442 | ||||||||
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| Practice Location | |||||||||
| Address1: | 256 MASON AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103053408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182266400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 12/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | ELSOUEIDI | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
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| AuthorizedOfficialTitleorPosition: | HEMATOLOGY/ONCOLOGY FELLOW | ||||||||
| AuthorizedOfficialTelephone: | 7182266400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 003191 | NY | Y | Hospitals | General Acute Care Hospital |
No ID Information.