Provider Demographics
NPI:1881885176
Name:ST. PETER'S HOSPITAL
Entity type:Organization
Organization Name:ST. PETER'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAVRINEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-8600
Mailing Address - Street 1:315 S MANNING BLVD
Mailing Address - Street 2:6509 CUSACK
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1707
Mailing Address - Country:US
Mailing Address - Phone:518-525-8600
Mailing Address - Fax:518-525-1759
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:6509 CUSACK
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-8600
Practice Address - Fax:518-525-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011930282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital