Healthcare Provider Details

I. General information

NPI: 1902989221
Provider Name (Legal Business Name): NEWARK WAYNE COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 DRIVING PARK AVE
NEWARK NY
14513-1057
US

IV. Provider business mailing address

1200 DRIVING PARK AVE
NEWARK NY
14513-1057
US

V. Phone/Fax

Practice location:
  • Phone: 315-332-2022
  • Fax:
Mailing address:
  • Phone: 315-332-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number5820000H
License Number StateNY

VIII. Authorized Official

Name: PAULA TINCH
Title or Position: SVP-FINANCE
Credential:
Phone: 585-922-1223