Provider Demographics
NPI:1700552775
Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO & TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCZENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-787-4030
Mailing Address - Street 1:418 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1070
Mailing Address - Country:US
Mailing Address - Phone:315-531-2000
Mailing Address - Fax:
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1070
Practice Address - Country:US
Practice Address - Phone:315-531-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOLDIERS & SAILORS MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02657812Medicaid