Provider Demographics
NPI:1760651855
Name:THE KINGSTON HOSPITAL
Entity Type:Organization
Organization Name:THE KINGSTON HOSPITAL
Other - Org Name:BRIDGEBACK OF THE KINGSTON HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PFS
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-943-6023
Mailing Address - Street 1:2 BARBAROSA LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-1220
Mailing Address - Country:US
Mailing Address - Phone:845-331-3131
Mailing Address - Fax:845-943-6077
Practice Address - Street 1:2 BARBAROSA LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1220
Practice Address - Country:US
Practice Address - Phone:845-331-3131
Practice Address - Fax:845-943-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
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
330004Medicare Oscar/Certification