Provider Demographics
NPI:1093258873
Name:NEWARK-WAYNE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:NEWARK-WAYNE COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-5497
Mailing Address - Street 1:1200 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1090
Mailing Address - Country:US
Mailing Address - Phone:585-426-1234
Mailing Address - Fax:585-247-2797
Practice Address - Street 1:1200 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1090
Practice Address - Country:US
Practice Address - Phone:585-426-1234
Practice Address - Fax:585-247-2797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWARK-WAYNE COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-28
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0654949291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory