Provider Demographics
NPI:1790958643
Name:VASSAR COLLEGE
Entity Type:Organization
Organization Name:VASSAR COLLEGE
Other - Org Name:VASSAR COLLEGE HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BALAWAJDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-437-5800
Mailing Address - Street 1:124 RAYMOND AVE
Mailing Address - Street 2:BOX 17
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12604-0001
Mailing Address - Country:US
Mailing Address - Phone:845-437-5800
Mailing Address - Fax:845-437-7135
Practice Address - Street 1:124 RAYMOND AVE
Practice Address - Street 2:BOX 17
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12604-0002
Practice Address - Country:US
Practice Address - Phone:845-437-5800
Practice Address - Fax:845-437-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150836-1261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health