Provider Demographics
NPI:1902022106
Name:ST. MARY'S HOSPITAL FOR CHILDREN
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDINGAND ASSOCIATE PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:NUNZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FATICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-281-8701
Mailing Address - Street 1:29-01 216TH STREET
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360
Mailing Address - Country:US
Mailing Address - Phone:718-281-8593
Mailing Address - Fax:718-281-8590
Practice Address - Street 1:2901 216TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2810
Practice Address - Country:US
Practice Address - Phone:718-281-8701
Practice Address - Fax:718-281-8590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153809282NC2000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282NC2000XHospitalsGeneral Acute Care HospitalChildren
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility