Healthcare Provider Details

I. General information

NPI: 1447227491
Provider Name (Legal Business Name): HEALTHALLIANCE MARYS AVENUE CAMPUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MARY'S AVE
KINGSTON NY
12401
US

IV. Provider business mailing address

105 MARY'S AVE
KINGSTON NY
12401
US

V. Phone/Fax

Practice location:
  • Phone: 845-943-6007
  • Fax: 845-943-6038
Mailing address:
  • Phone: 845-943-6007
  • Fax: 845-943-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN SCHUPP
Title or Position: DIRECTOR, PATIENT ACCOUNTS
Credential:
Phone: 845-943-6007