1821184839 NPI number — DOMINICAN SISTERS FAMILY HEALTH SERVICE INC

Table of content: (NPI 1821184839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821184839 NPI number — DOMINICAN SISTERS FAMILY HEALTH SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINICAN SISTERS FAMILY HEALTH SERVICE 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:
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:
1821184839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 N HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSSINING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10562-2327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-941-1710
Provider Business Mailing Address Fax Number:
914-941-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSSINING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10562-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-941-1710
Provider Business Practice Location Address Fax Number:
914-941-0518
Provider Enumeration Date:
10/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZAGAJESKI
Authorized Official First Name:
MARY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
914-941-1710

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  5905601 , 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: 00321971 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".