Provider Demographics
NPI:1679573083
Name:BLYTHEDALE CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:BLYTHEDALE CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-592-7138
Mailing Address - Street 1:95 BRADHURST AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1637
Mailing Address - Country:US
Mailing Address - Phone:914-592-7555
Mailing Address - Fax:914-592-0381
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-592-7555
Practice Address - Fax:914-592-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5957000H283XC2000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes283XC2000XHospitalsRehabilitation HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333301Medicare Oscar/Certification