Basic Information
| Provider Information | |||||||||
| NPI: | 1104473990 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLE FALLS HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LITTLE FALLS HOSPITAL ST JOHNSVILLE HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 BURWELL STREET | ||||||||
| Address2: | |||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133651725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158235281 | ||||||||
| FaxNumber: | 3158235383 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 PARK PL | ||||||||
| Address2: | |||||||||
| City: | ST JOHNSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134521332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185683403 | ||||||||
| FaxNumber: | 5185683216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | VIELKIND | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3158235281 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.