Provider Demographics
NPI:1467593202
Name:LITTLE FALLS HOSPITAL
Entity Type:Organization
Organization Name:LITTLE FALLS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VIELKIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-823-5281
Mailing Address - Street 1:140 BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1725
Mailing Address - Country:US
Mailing Address - Phone:315-823-5281
Mailing Address - Fax:315-823-5383
Practice Address - Street 1:140 BURWELL ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NY
Practice Address - Zip Code:13365-1725
Practice Address - Country:US
Practice Address - Phone:315-823-5281
Practice Address - Fax:315-823-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211649207Q00000X
NY219951207Q00000X
NY122476207QA0505X, 208600000X
NY170400207ZP0102X
NYF331459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310870Medicaid
NY70257KMedicare PIN
NY00310870Medicaid