Healthcare Provider Details

I. General information

NPI: 1790805265
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF NY PRESBYTERIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY 5 TOWER
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

53 VISTA DR
NANUET NY
10954-3822
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-8530
  • Fax:
Mailing address:
  • Phone: 845-356-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberF381746
License Number StateNY

VIII. Authorized Official

Name: MISS DEBRA MARTONE
Title or Position: CERTIFIED PED NURSE PRACTITIONER
Credential: CPNP
Phone: 212-342-8530