Healthcare Provider Details

I. General information

NPI: 1750771010
Provider Name (Legal Business Name): BLYTHEDALE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-7555
  • Fax:
Mailing address:
  • Phone: 914-592-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00274057
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MR. EDWARD NG
Title or Position: DIRECTOR, PATIENT ACCOUNTS
Credential:
Phone: 914-592-7555