Provider Demographics
NPI:1346326006
Name:GOOD SAMARITAN HOSPITAL OF SUFFERN
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL OF SUFFERN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, HOME CARE
Authorized Official - Prefix:MISS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-368-5278
Mailing Address - Street 1:1 CROSFIELD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2229
Mailing Address - Country:US
Mailing Address - Phone:845-294-2015
Mailing Address - Fax:845-615-0923
Practice Address - Street 1:1 CROSFIELD AVE STE 202
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2229
Practice Address - Country:US
Practice Address - Phone:845-294-2015
Practice Address - Fax:845-615-0923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN HOSPITAL OF SUFFERN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA1132664OtherOXFORD
NY03000126Medicaid
NY1000003452OtherAFFINITY INSURANCE
NY00273941Medicaid
NY0097476OtherAETNA
NY0097476OtherAETNA