Healthcare Provider Details

I. General information

NPI: 1083709703
Provider Name (Legal Business Name): ST. MARY'S HOSPITAL FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
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: 718-279-2141
Mailing address:
  • Phone: 718-281-8800
  • Fax: 718-279-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number33-A081
License Number StateNY

VIII. Authorized Official

Name: DR. BURTON GREBIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 718-281-8888