Provider Demographics
NPI:1013306059
Name:DOWNSTATE CORRECTIONAL FACILTY
Entity Type:Organization
Organization Name:DOWNSTATE CORRECTIONAL FACILTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILTY HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALVAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-831-6600
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-0445
Mailing Address - Country:US
Mailing Address - Phone:845-831-6600
Mailing Address - Fax:845-831-6794
Practice Address - Street 1:121 RED SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2810
Practice Address - Country:US
Practice Address - Phone:845-831-6600
Practice Address - Fax:845-831-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336460-1261QP0905X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No302F00000XManaged Care OrganizationsExclusive Provider Organization