1114969482 NPI number — HOSPITALIST EMO OF NY, PC

Table of content: (NPI 1114969482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114969482 NPI number — HOSPITALIST EMO OF NY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITALIST EMO OF NY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114969482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 597
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07039-0597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-740-9396
Provider Business Mailing Address Fax Number:
973-740-9895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 N MIDLAND AVE
Provider Second Line Business Practice Location Address:
NYACK HOSPITAL
Provider Business Practice Location Address City Name:
NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10960-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-348-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IANNACCONE
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM PRESIDENT / CEO
Authorized Official Telephone Number:
973-740-0706

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02673536 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".