1285601237 NPI number — HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS

Table of content: (NPI 1285601237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285601237 NPI number — HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHALLIANCE HOSPITAL MARYS AVENUE 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:
BENEDICTINE HOSPITAL
Provider Other Organization Name Type Code:
4
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:
1285601237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 MARYS AVE
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:
12401-5829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-943-6007
Provider Business Mailing Address Fax Number:
845-943-6038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 MARYS AVE
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:
12401-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-943-6007
Provider Business Practice Location Address Fax Number:
845-943-6038
Provider Enumeration Date:
03/08/2006

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: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: UV5282 . This is a "MVP HEALTH PLAN PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000702 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6450795 . This is a "AETNA PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00274020 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143278 . This is a "VALUE OPTIONS PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10005742 . This is a "CDPHP PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3185 . This is a "GHI PROVIDER ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 103185 . This is a "WELLCARE PROV ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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