Provider Demographics
NPI:1598755324
Name:ST. ANTHONY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:ST. ANTHONY COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-987-5317
Mailing Address - Street 1:15-19 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990
Mailing Address - Country:US
Mailing Address - Phone:845-987-5317
Mailing Address - Fax:845-986-2687
Practice Address - Street 1:15 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1028
Practice Address - Country:US
Practice Address - Phone:845-987-5317
Practice Address - Fax:845-986-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH04399OtherOXFORD
NYIC0509OtherHEALTHNET
NYIC0510OtherPHS
NY14040OtherUS HEALTHCARE
NY00273890Medicaid
NY76445OtherMVP
NY4158105Medicaid
NY0004845000OtherAMERIHEALTH
NY000960OtherBLUE CROSS
NY000000004578OtherGHI HMO
NY=========OtherCOMMERCIAL,COMP,NF,HMO
NY0004845000OtherAMERIHEALTH