Healthcare Provider Details

I. General information

NPI: 1396043501
Provider Name (Legal Business Name): ST. ANTHONY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAPLE AVE
WARWICK NY
10990-1028
US

IV. Provider business mailing address

20 GRAND ST 3RD FLOOR
WARWICK NY
10990-1035
US

V. Phone/Fax

Practice location:
  • Phone: 845-986-2276
  • Fax:
Mailing address:
  • Phone: 866-474-3900
  • Fax: 845-987-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number105585
License Number StateNY

VIII. Authorized Official

Name: MRS. NANCY VANDEMARK
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 845-987-3952