Healthcare Provider Details

I. General information

NPI: 1578526695
Provider Name (Legal Business Name): ST. JOHN'S RIVERSIDE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 N BROADWAY
YONKERS NY
10701-1301
US

IV. Provider business mailing address

967 N BROADWAY
YONKERS NY
10701-1301
US

V. Phone/Fax

Practice location:
  • Phone: 914-964-4205
  • Fax: 914-964-7751
Mailing address:
  • Phone: 914-964-4444
  • Fax: 914-964-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateNY

VIII. Authorized Official

Name: GLADYS ATTANASIO
Title or Position: AVP REV CYCLE
Credential:
Phone: 914-964-4205