1215989041 NPI number — HEALTHALLIANCE HOSPITAL MARY'S AVE CAMPUS

Table of content: (NPI 1215989041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215989041 NPI number — HEALTHALLIANCE HOSPITAL MARY'S AVE CAMPUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHALLIANCE HOSPITAL MARY'S AVE CAMPUS
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:
HEALTH ALLIANCE DIALYSIS
Provider Other Organization Name Type Code:
3
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:
1215989041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
396 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12401-4652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-331-3131
Provider Business Mailing Address Fax Number:
845-943-6077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 ALBANY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-943-6023
Provider Business Practice Location Address Fax Number:
845-943-6077
Provider Enumeration Date:
05/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RATNER
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
914-493-2961

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00274048 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03000204 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".