1902890049 NPI number — LITTLE FALLS HOSPITAL

Table of content: KIMBERLY DANE GRAHAM NP (NPI 1639273170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902890049 NPI number — LITTLE FALLS HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LITTLE FALLS 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:
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:
1902890049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13057-4505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-449-0513
Provider Business Mailing Address Fax Number:
315-445-2936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 BURWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13365-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-823-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VIELKIND
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
315-823-1000

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02500452 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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