Basic Information
| Provider Information | |||||||||
| NPI: | 1467593202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LITTLE FALLS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 BURWELL ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133651725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158235281 | ||||||||
| FaxNumber: | 3158235383 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 BURWELL ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133651725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158235281 | ||||||||
| FaxNumber: | 3158235383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | VIELKIND | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3158235281 | ||||||||
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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 | 207ZP0102X | 170400 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207Q00000X | 219951 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0505X | 122476 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 208600000X | 122476 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 363LF0000X | F331459 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | 211649 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00310870 | 05 | NY | MEDICAID |