Basic Information
Provider Information | |||||||||
NPI: | 1912554791 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LITTLE FALLS HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | LITTLE FALLS HOSPITAL RICHFIELD SPRINGS HEALTH CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 140 BURWELL STREET | ||||||||
Address2: |   | ||||||||
City: | LITTLE FALLS | ||||||||
State: | NY | ||||||||
PostalCode: | 133651725 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3158235281 | ||||||||
FaxNumber: | 3158235383 | ||||||||
Practice Location | |||||||||
Address1: | 8550 STATE HIGHWAY 28 | ||||||||
Address2: |   | ||||||||
City: | RICHFIELD SPRINGS | ||||||||
State: | NY | ||||||||
PostalCode: | 134394830 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3158580040 | ||||||||
FaxNumber: | 3158580075 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/26/2019 | ||||||||
LastUpdateDate: | 02/07/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | VIELKIND | ||||||||
AuthorizedOfficialFirstName: | JAMES | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT FINANCE | ||||||||
AuthorizedOfficialTelephone: | 3158235281 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/07/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.