Basic Information
| Provider Information | |||||||||
| NPI: | 1932322047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT VINCENT CATHOLIC MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | ST. VINCENT'S HOSPITAL WESTCHESTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 450 W 33RD ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123564419 | ||||||||
| FaxNumber: | 2123564439 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 NORTH STREET | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105281524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149255434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YORKE | ||||||||
| AuthorizedOfficialFirstName: | DOLLYANN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 2123564419 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT VINCENT CATHOLIC MEDICAL CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 7002037 | NY | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 3355294 | 01 | NAPB | OTHER | 00243229 | 05 | NY | MEDICAID |