Healthcare Provider Details

I. General information

NPI: 1255652871
Provider Name (Legal Business Name): BELLEVUE HOSPITAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

540 E 20TH ST APT 7A
NEW YORK NY
10009-1333
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-6219
  • Fax:
Mailing address:
  • Phone: 247-321-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number003516
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number003516
License Number StateNY

VIII. Authorized Official

Name: DR. MARY ANNE BADARACCO
Title or Position: DIRECTOR OF PSYCHIATRY
Credential: M.D.
Phone: 212-263-6219