Healthcare Provider Details

I. General information

NPI: 1124118104
Provider Name (Legal Business Name): ST LUKE'S CORNWALL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE ST LUKE'S CORNWALL HOSPITAL, FINANCE DEPT
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

19 LAUREL AVE ST LUKE'S CORNWALL HOSPITAL, FINANCE DEPT
CORNWALL NY
12518-1403
US

V. Phone/Fax

Practice location:
  • Phone: 845-458-4023
  • Fax: 845-458-4040
Mailing address:
  • Phone: 845-458-4023
  • Fax: 845-458-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JILL G BARTON
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 845-458-4023