Basic Information
| Provider Information | |||||||||
| NPI: | 1407815830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. CATHERINE OF SIENA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 96000-6565 | ||||||||
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| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191956565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 ROUTE 25A | ||||||||
| Address2: | |||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117871348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318623000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | POHLMAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6318623107 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 02060942 | 05 | NY | MEDICAID | 000335 | 01 | NY | BLUE CROSS | OTHER |