Provider Demographics
NPI:1770671182
Name:NEWARK WAYNE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:NEWARK WAYNE COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/EXEC. VP
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CRILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-5497
Mailing Address - Street 1:1200 DRIVING PARK AVE
Mailing Address - Street 2:P.O. BOX 111 DRIVING PARK AVE
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-332-2022
Mailing Address - Fax:
Practice Address - Street 1:1200 DRIVING PARK AVE
Practice Address - Street 2:POB 111 DRIVING PARK AVE
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-332-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5820000H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03001654Medicaid
NY014002611OtherBLUE CHOICE OUTPATIENT
NYESHO1301OtherPREFERRED CARE INPATIENT
NYCA3158OtherRAILROAD MEDICARE
NYHO1300OtherPREFERRED CARE
NY012002611OtherBLUE CHOICE INPATIENT
NY00354458Medicaid
NY330030Medicare Oscar/Certification