1346213469 NPI number — GOOD SAMARITAN HOSPITAL OF SUFFERN

Table of content: (NPI 1346213469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346213469 NPI number — GOOD SAMARITAN HOSPITAL OF SUFFERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITAN HOSPITAL OF SUFFERN
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:
1346213469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 LAFAYETTE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFERN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10901-4846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-368-5000
Provider Business Mailing Address Fax Number:
845-368-5430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 LAFAYETTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUFFERN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10901-4846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-368-5000
Provider Business Practice Location Address Fax Number:
845-368-5430
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEAHY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP
Authorized Official Telephone Number:
845-368-5000

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007297990002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ID0063 . This is a "PHS SMART CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040401000867 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 337015 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0009822 . This is a "US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1007297990003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ID0062 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000004579 . This is a "GHI/HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000153 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4155408 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4579 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: H03129 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 913 . This is a "ANTHEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00273941 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017647800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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