Provider Demographics
NPI:1710131420
Name:ST. JOHN'S EPISCOPAL HOSPITAL
Entity Type:Organization
Organization Name:ST. JOHN'S EPISCOPAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PATIENT ACCOUNTS
Authorized Official - Prefix:MR
Authorized Official - First Name:NED
Authorized Official - Middle Name:
Authorized Official - Last Name:RINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-349-2901
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11690-1386
Mailing Address - Country:US
Mailing Address - Phone:516-349-2961
Mailing Address - Fax:516-349-2914
Practice Address - Street 1:327 BEACH 19TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4423
Practice Address - Country:US
Practice Address - Phone:516-349-2961
Practice Address - Fax:516-349-2914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPISCOPAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-07
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65140Medicare PIN