Provider Demographics
NPI:1790010817
Name:SAINT VINCENTS CATHOLIC MEDICAL CENTERS OF NEW YORK
Entity Type:Organization
Organization Name:SAINT VINCENTS CATHOLIC MEDICAL CENTERS OF NEW YORK
Other - Org Name:MITCHEL FIELD FAMILY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-356-5962
Mailing Address - Street 1:5 PENN PLZ FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1851
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WEST ROAD
Practice Address - Street 2:BUILDING 19
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-222-0228
Practice Address - Fax:516-745-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002037H261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243229Medicaid
NY00243229Medicaid