1700049145 NPI number — EPISCOPAL HEALTH SERVICES INC

Table of content: (NPI 1700049145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700049145 NPI number — EPISCOPAL HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPISCOPAL HEALTH SERVICES INC
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:
ST JOHN'S EPISCOPAL HOSPITAL- ESRD
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:
1700049145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
377 OAK ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-6542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-869-8578
Provider Business Mailing Address Fax Number:
718-869-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 BEACH 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-869-7000
Provider Business Practice Location Address Fax Number:
718-869-8507
Provider Enumeration Date:
07/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BATISTA
Authorized Official First Name:
BERTRAND
Authorized Official Middle Name:
Authorized Official Title or Position:
VP REVENUE CYCLE MANAGEMENT
Authorized Official Telephone Number:
917-450-2492

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  7001024H , 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: 000085 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00729382 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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