Provider Demographics
NPI:1780052514
Name:VASSAR BROTHERS MEDICAL CENTER
Entity type:Organization
Organization Name:VASSAR BROTHERS MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEHRBOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-475-9946
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-454-8500
Mailing Address - Fax:845-475-9915
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-8500
Practice Address - Fax:845-475-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302001H291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
103527OtherWELLCARE
HO5540OtherOXFORD
NY00273854Medicaid
3527OtherGHI
70026OtherMVP
10019452OtherCDPHP
00206OtherBLUE CROSS
70026OtherMVP