Provider Demographics
NPI:1801132923
Name:DELAWARE VALLEY HOSPITAL, INC
Entity type:Organization
Organization Name:DELAWARE VALLEY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-865-2197
Mailing Address - Street 1:1 TITUS PL
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1457
Mailing Address - Country:US
Mailing Address - Phone:607-865-2100
Mailing Address - Fax:
Practice Address - Street 1:2 TITUS PL
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1455
Practice Address - Country:US
Practice Address - Phone:607-865-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347571Medicaid
NY00347571Medicaid