Healthcare Provider Details

I. General information

NPI: 1992928071
Provider Name (Legal Business Name): ST MARY'S HOSPITAL FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 216TH ST
BAYSIDE NY
11360-2810
US

IV. Provider business mailing address

2901 216TH ST
BAYSIDE NY
11360-2810
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-8800
  • Fax:
Mailing address:
  • Phone: 718-281-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number700330N
License Number StateNY

VIII. Authorized Official

Name: MS. FREDERIQUE ALTIDOR
Title or Position: MANAGER
Credential:
Phone: 718-281-8688