Provider Demographics
NPI:1639197551
Name:MEDICAL ARTS SANITARIUM, INC.
Entity Type:Organization
Organization Name:MEDICAL ARTS SANITARIUM, INC.
Other - Org Name:CORNERSTONE OF MEDICAL ARTS CENTER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONIFATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-906-6700
Mailing Address - Street 1:15905 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1950
Mailing Address - Country:US
Mailing Address - Phone:718-906-6700
Mailing Address - Fax:718-906-6814
Practice Address - Street 1:15905 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1950
Practice Address - Country:US
Practice Address - Phone:718-906-6700
Practice Address - Fax:718-906-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00273056Medicaid