Provider Demographics
NPI:1417245226
Name:EPISCOPAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:EPISCOPAL HEALTH SERVICES INC
Other - Org Name:ST. JOHN'S EPISCOPAL HOSPITAL, SOUTH SHORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE CONTROLL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALATHRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-349-5227
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-349-5227
Mailing Address - Fax:
Practice Address - Street 1:230 BEACH 102ND ST
Practice Address - Street 2:SUITE 5B
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2861
Practice Address - Country:US
Practice Address - Phone:718-474-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPISOCPAL HEALTH SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-13
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02237718Medicaid