Provider Demographics
NPI:1114969482
Name:HOSPITALIST EMO OF NY, PC
Entity Type:Organization
Organization Name:HOSPITALIST EMO OF NY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNACCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-740-0706
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0597
Mailing Address - Country:US
Mailing Address - Phone:973-740-9396
Mailing Address - Fax:973-740-9895
Practice Address - Street 1:160 N MIDLAND AVE
Practice Address - Street 2:NYACK HOSPITAL
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1912
Practice Address - Country:US
Practice Address - Phone:845-348-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02673536Medicaid
NYWEW451Medicare ID - Type Unspecified