Healthcare Provider Details

I. General information

NPI: 1093789117
Provider Name (Legal Business Name): THE MOUNT VERNON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 7TH AVE
MOUNT VERNON NY
10550-2026
US

IV. Provider business mailing address

12 N 7TH AVE
MOUNT VERNON NY
10550-2026
US

V. Phone/Fax

Practice location:
  • Phone: 914-664-8000
  • Fax: 914-664-8015
Mailing address:
  • Phone: 914-664-8000
  • Fax: 914-664-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GEORGE HASKINS
Title or Position: CFO
Credential:
Phone: 914-664-8000