Healthcare Provider Details

I. General information

NPI: 1902176050
Provider Name (Legal Business Name): BLYTHEDALE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595
US

IV. Provider business mailing address

95 BRADHURST AVE
VALHALLA NY
10595
US

V. Phone/Fax

Practice location:
  • Phone: 914-831-2485
  • Fax: 914-593-0186
Mailing address:
  • Phone: 914-831-2485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD NG
Title or Position: DIRECTOR PATIENT ACCOUNTS
Credential:
Phone: 914-831-2485