Provider Demographics
NPI:1679797955
Name:ST. JOSEPH'S HOSPTIAL
Entity Type:Organization
Organization Name:ST. JOSEPH'S HOSPTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LACROIX
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP, MS
Authorized Official - Phone:716-891-2612
Mailing Address - Street 1:P.O. BOX 222
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14205-0222
Mailing Address - Country:US
Mailing Address - Phone:905-658-1043
Mailing Address - Fax:
Practice Address - Street 1:2605 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-0225
Practice Address - Country:US
Practice Address - Phone:716-891-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430295282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital