Healthcare Provider Details

I. General information

NPI: 1881856201
Provider Name (Legal Business Name): SAINT VINCENT CATHOLIC MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W 12TH ST REISS 180
NEW YORK NY
10011-8202
US

IV. Provider business mailing address

144 W 12TH ST REISS 180
NEW YORK NY
10011-8202
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-8188
  • Fax: 212-604-3778
Mailing address:
  • Phone: 212-604-8188
  • Fax: 212-604-3778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberR053792
License Number StateNY

VIII. Authorized Official

Name: DR. BRIAN FITZSIMMONS
Title or Position: SR VP, EXEC DIR BEHAVIORAL HEALTH
Credential: PHD
Phone: 914-925-5300