Provider Demographics
NPI:1164481529
Name:ST. CHARLES HOSPITAL
Entity Type:Organization
Organization Name:ST. CHARLES HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-474-6116
Mailing Address - Street 1:PO BOX 95000-6570
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-6570
Mailing Address - Country:US
Mailing Address - Phone:631-474-6000
Mailing Address - Fax:
Practice Address - Street 1:200 BELLE TERRE ROAD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11714-5713
Practice Address - Country:US
Practice Address - Phone:631-474-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00274415Medicaid
NY000200OtherBLUE CROSS
330246Medicare ID - Type Unspecified