Basic Information
| Provider Information | |||||||||
| NPI: | 1740442870 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GARNET HEALTH MEDICAL CENTER CATSKILLS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CATSKILL REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 900 | ||||||||
| Address2: | |||||||||
| City: | HARRIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457943300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8881 NYS ROUTE 97 | ||||||||
| Address2: | |||||||||
| City: | CALLICOON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458875530 | ||||||||
| FaxNumber: | 8458875380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DAVISON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUDGET, REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 8453337446 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | NY | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 00273978 | 05 | NY | MEDICAID |