Provider Demographics
NPI:1578635561
Name:ELIZABETH SETON PEDIATRIC CENTER
Entity Type:Organization
Organization Name:ELIZABETH SETON PEDIATRIC CENTER
Other - Org Name:ELIZABETH SETON CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:M. CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-294-6128
Mailing Address - Street 1:300 CORPORATE BLVD S
Mailing Address - Street 2:FINANCE DEPT.
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6862
Mailing Address - Country:US
Mailing Address - Phone:914-294-6129
Mailing Address - Fax:914-294-6181
Practice Address - Street 1:300 CORPORATE BLVD S
Practice Address - Street 2:FINANCE DEPT.
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6862
Practice Address - Country:US
Practice Address - Phone:914-294-6129
Practice Address - Fax:914-294-6181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002346N3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01095110Medicaid
2126300OtherPK
NY01095110Medicaid