Healthcare Provider Details

I. General information

NPI: 1215989041
Provider Name (Legal Business Name): HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 ALBANY AVENUE
KINGSTON NY
12401-2902
US

IV. Provider business mailing address

105 MARYS AVE
KINGSTON NY
12401-5829
US

V. Phone/Fax

Practice location:
  • Phone: 845-943-6023
  • Fax: 845-943-6077
Mailing address:
  • Phone: 845-943-6023
  • Fax: 845-943-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK BAKER
Title or Position: AVP, REVENUE CYCLE
Credential:
Phone: 914-493-2846