1124118104 NPI number — ST LUKE'S CORNWALL HOSPITAL

Table of content: (NPI 1124118104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124118104 NPI number — ST LUKE'S CORNWALL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKE'S CORNWALL HOSPITAL
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:
BEHAVIORAL HEALTH UNIT
Provider Other Organization Name Type Code:
5
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:
1124118104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 LAUREL AVE
Provider Second Line Business Mailing Address:
ST LUKE'S CORNWALL HOSPITAL, FINANCE DEPT
Provider Business Mailing Address City Name:
CORNWALL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12518-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-458-4023
Provider Business Mailing Address Fax Number:
845-458-4040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 LAUREL AVE
Provider Second Line Business Practice Location Address:
ST LUKE'S CORNWALL HOSPITAL, FINANCE DEPT
Provider Business Practice Location Address City Name:
CORNWALL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12518-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-458-4023
Provider Business Practice Location Address Fax Number:
845-458-4040
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARTON
Authorized Official First Name:
JILL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
845-458-4023

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02915662 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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