1295765840 NPI number — ST. JOHN'S RIVERSIDE HOSPITAL-PATHOLOGY

Table of content: (NPI 1295765840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295765840 NPI number — ST. JOHN'S RIVERSIDE HOSPITAL-PATHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN'S RIVERSIDE HOSPITAL-PATHOLOGY
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:
1295765840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 998
Provider Second Line Business Mailing Address:
ATTN: RIVERSIDE MANAGEMENT SERVICES ORG
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10703-0998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-966-9787
Provider Business Mailing Address Fax Number:
914-966-9793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
967 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-966-9787
Provider Business Practice Location Address Fax Number:
914-966-9793
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UGALDE
Authorized Official First Name:
SILVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT VICE PRESIDENT
Authorized Official Telephone Number:
914-964-9787

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com