1114095171 NPI number — SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE

Table of content: BERNADETTE MARIE MCDONALD ARNP (NPI 1811284813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114095171 NPI number — SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SETON HEALTH AT SCHUYLER RIDGE RESIDENTIAL HEALTHCARE
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:
1114095171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 ABELE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFTON PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12065-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-371-1400
Provider Business Mailing Address Fax Number:
518-371-1240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ABELE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIFTON PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12065-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-371-1400
Provider Business Practice Location Address Fax Number:
518-371-1240
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
518-275-4258

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  4552300N , 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: 02994094 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33-5774 . This is a "MEDICARE A PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01470539 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: J100000128 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".




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