Healthcare Provider Details

I. General information

NPI: 1093981557
Provider Name (Legal Business Name): ST MARYS HOSPITAL FOR CHILDREN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 216TH ST ATTN: PHARMACY
BAYSIDE NY
11360-2810
US

IV. Provider business mailing address

2901 216TH ST ATTN: PHARMACY
BAYSIDE NY
11360-2810
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-8866
  • Fax:
Mailing address:
  • Phone: 718-281-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. EDDIE SIMPSER
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 718-281-8886