1497795785 NPI number — ST PETERS HOSPITAL

Table of content: (NPI 1497795785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497795785 NPI number — ST PETERS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST PETERS HOSPITAL
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 PETERS HOSPITAL REHAB UNIT
Provider Other Organization Name Type Code:
5
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:
1497795785
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:
315 S MANNING BLVD
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:
12208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-275-4087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 S MANNING BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208-1789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-275-4087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAVIN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO TREASURER
Authorized Official Telephone Number:
518-525-1499

Provider Taxonomy Codes

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

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

  • Identifier: 10005852 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000022 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000400022000 . This is a "NORTHEASTERN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00318823 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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