Provider Demographics
NPI:1821430455
Name:ST.MARYS HEALTHCARE SYSTEM FOR CHILDREN
Entity Type:Organization
Organization Name:ST.MARYS HEALTHCARE SYSTEM FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECRUITER OF HUMAN RESOURCES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSPODARCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-281-8640
Mailing Address - Street 1:15218 UNION TPKE APT 10R
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3926
Mailing Address - Country:US
Mailing Address - Phone:917-254-9080
Mailing Address - Fax:
Practice Address - Street 1:5 DAKOTA DR STE 204
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1109
Practice Address - Country:US
Practice Address - Phone:718-281-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1416829252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency