Provider Demographics
NPI: | 1518042357 |
---|---|
Name: | ST. PETER'S HOSPITAL OF THE CITY OF ALBANY |
Entity Type: | Organization |
Organization Name: | ST. PETER'S HOSPITAL OF THE CITY OF ALBANY |
Other - Org Name: | ST. PETER'S INPATIENT SPEECH PATHOLOGY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CREDENTIALING & ENROLLMENT MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | COURTNEY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KNOWLES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 518-525-5634 |
Mailing Address - Street 1: | PO BOX 14890 |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBANY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12212-4890 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 315 SOUTH MANNING BLVD |
Practice Address - Street 2: | |
Practice Address - City: | ALBANY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12208-1707 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-525-1550 |
Practice Address - Fax: | 518-275-4090 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ST. PETER'S HOSPITAL OF THE CITY OF ALBANY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-10-26 |
Last Update Date: | 2023-08-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
No | 283X00000X | Hospitals | Rehabilitation Hospital | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 03011194 | Medicaid | |
NY | 70034A | Medicare PIN |