Basic Information
| Provider Information | |||||||||
| NPI: | 1578526695 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. JOHN'S RIVERSIDE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 967 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149644444 | ||||||||
| FaxNumber: | 9149644717 | ||||||||
| Practice Location | |||||||||
| Address1: | 967 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149644205 | ||||||||
| FaxNumber: | 9149647751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | ATTANASIO | ||||||||
| AuthorizedOfficialFirstName: | GLADYS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | AVP REV CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 9149644205 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282N00000X | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00245501 | 05 | NY | MEDICAID |