Healthcare Provider Details

I. General information

NPI: 1497795785
Provider Name (Legal Business Name): ST PETERS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD
ALBANY NY
12208-1789
US

IV. Provider business mailing address

315 S MANNING BLVD
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-275-4087
  • Fax:
Mailing address:
  • Phone: 518-275-4087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES GAVIN
Title or Position: CFO TREASURER
Credential:
Phone: 518-525-1499