1053466425 NPI number — ST. PETER'S HOSPITAL OF THE CITY OF ALBANY

Table of content: (NPI 1053466425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053466425 NPI number — ST. PETER'S HOSPITAL OF THE CITY OF ALBANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. PETER'S HOSPITAL OF THE CITY OF ALBANY
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:
6
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:
1053466425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12212-4890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-275-4090
Provider Business Mailing Address Fax Number:
518-275-4004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PINE WEST PLAZA
Provider Second Line Business Practice Location Address:
WASHINGTON AVE EXT
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-5537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-464-9999
Provider Business Practice Location Address Fax Number:
518-464-9650
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KNOWLES
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING & ENROLLMENT MANAGER
Authorized Official Telephone Number:
518-525-5634

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 892050 . This is a "MVP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10087013 . This is a "CDPH PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000400597002 . This is a "BLUE SHIELD PROVIDER NUMB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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