Provider Demographics
NPI:1780836833
Name:ST VINCENTS PEDIATRIC DEPT
Entity Type:Organization
Organization Name:ST VINCENTS PEDIATRIC DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:JURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-356-5922
Mailing Address - Street 1:450 W 33RD ST
Mailing Address - Street 2:PBS 12TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2603
Mailing Address - Country:US
Mailing Address - Phone:212-356-4765
Mailing Address - Fax:
Practice Address - Street 1:170 W 12TH ST
Practice Address - Street 2:SMITH 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:212-604-7878
Practice Address - Fax:212-356-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty