Provider Demographics
NPI:1801089495
Name:NEWARK WAYNE COMMUNITY HOSPITAL-LAB
Entity type:Organization
Organization Name:NEWARK WAYNE COMMUNITY HOSPITAL-LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1223
Mailing Address - Street 1:1200 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-332-2022
Mailing Address - Fax:
Practice Address - Street 1:1200 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-332-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWARK WAYNE COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11SOtherEXCELLUS-BCR
NYP013002611OtherEXCELLUS-BCH
NYP013002611OtherEXCELLUS-BCH