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General NPI Number Information
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NPI Number | 1083709703
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HOSPITAL FOR CHILDREN
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2901 216TH ST
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City | BAYSIDE
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State | NY
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Zip | 11360-2810
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Country | US
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Telephone | 718-281-8800
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Fax | 718-279-2141
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Provider Business Mailing Address
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Address Line | 2901 216TH ST
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City | BAYSIDE
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State | NY
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Zip | 11360-2810
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Country | US
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Telephone | 718-281-8800
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Fax | 718-279-2141
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. BURTON GREBIN
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Credential | M.D.
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Telephone | 718-281-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 33-A081
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License Number State | NY
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