1902022106 NPI number — ST. MARY'S HOSPITAL FOR CHILDREN

Table of content: (NPI 1902022106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902022106 NPI number — ST. MARY'S HOSPITAL FOR CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S HOSPITAL FOR CHILDREN
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:
1902022106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29-01 216TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-281-8593
Provider Business Mailing Address Fax Number:
718-281-8590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 216TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11360-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-281-8701
Provider Business Practice Location Address Fax Number:
718-281-8590
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FATICA
Authorized Official First Name:
NUNZIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ATTENDINGAND ASSOCIATE PROFESSOR
Authorized Official Telephone Number:
718-281-8701

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  153809 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 153809 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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