Provider Demographics
NPI:1093981557
Name:ST MARYS HOSPITAL FOR CHILDREN INC.
Entity Type:Organization
Organization Name:ST MARYS HOSPITAL FOR CHILDREN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-281-8886
Mailing Address - Street 1:2901 216TH ST
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2810
Mailing Address - Country:US
Mailing Address - Phone:718-281-8866
Mailing Address - Fax:
Practice Address - Street 1:2901 216TH ST
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2810
Practice Address - Country:US
Practice Address - Phone:718-281-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3140N1450X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01528069Medicaid