Basic Information
| Provider Information | |||||||||
| NPI: | 1316975519 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT VINCENT CATHOLIC MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 W 33RD ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564419 | ||||||||
| FaxNumber: | 2123564439 | ||||||||
| Practice Location | |||||||||
| Address1: | 153 W 11TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100118305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564419 | ||||||||
| FaxNumber: | 2123564439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | YORKE | ||||||||
| AuthorizedOfficialFirstName: | DOLLYANN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 2123564419 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT VINCENT CATHOLIC MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 7002037H | NY | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 00840-8 | 01 | NY | BLUE CROSS PSYCH | OTHER |