1972557379 NPI number — PUTNAM HOSPITAL CENTER

Table of content: (NPI 1972557379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972557379 NPI number — PUTNAM HOSPITAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUTNAM HOSPITAL CENTER
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:
1972557379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 STONELEIGH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10512-3997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-279-5711
Provider Business Mailing Address Fax Number:
845-838-8062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 STONELEIGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10512-3997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-279-5711
Provider Business Practice Location Address Fax Number:
845-838-8062
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARCELLUS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ASST VP PATIENT FINANCIAL SERVICES
Authorized Official Telephone Number:
845-838-6361

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  3950000H , 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: ID0021 . This is a "CARE CORE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ID0021 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4581 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 702915 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91193 . This is a "GHI PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00208 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: HO3070 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6450460 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00258360 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10017913 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com