Provider Demographics
NPI:1265484489
Name:HEALTHALLIANCE HOSPITAL BROADWAY CAMPUS
Entity Type:Organization
Organization Name:HEALTHALLIANCE HOSPITAL BROADWAY CAMPUS
Other - Org Name:THE KINGSTON HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSICOVETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-334-2750
Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4652
Mailing Address - Country:US
Mailing Address - Phone:845-331-3131
Mailing Address - Fax:845-943-6077
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4652
Practice Address - Country:US
Practice Address - Phone:845-331-3131
Practice Address - Fax:845-943-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00274048Medicaid
NY330004Medicare Oscar/Certification