Provider Demographics
NPI:1770671448
Name:NATHAN LITTAUER HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:NATHAN LITTAUER HOSPITAL ASSOCIATION
Other - Org Name:NATHAN LITTAUER PRIMARY/SPECIALTY CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PRIMARY/SPECIAL CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-773-5728
Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-775-4205
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-775-4205
Practice Address - Fax:518-775-4225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATHAN LITTAUER HOPITAL AND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1701000H261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313924Medicaid
NY330276Medicare Oscar/Certification
NY55776AMedicare PIN