Healthcare Provider Details

I. General information

NPI: 1275793465
Provider Name (Legal Business Name): BLYTHEDALE CHILDRENS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

8 CLAUDIA CT
TAPPAN NY
10983-1936
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-7555
  • Fax: 914-592-0712
Mailing address:
  • Phone: 845-365-6741
  • Fax: 845-365-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number380734
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. REGINA KELLY
Title or Position: VICE PRESIDENT
Credential:
Phone: 914-592-7555