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General NPI Number Information
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NPI Number | 1104947654
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HOSPITAL
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 530 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-5700
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Country | US
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Telephone | 973-470-3165
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Fax |
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Provider Business Mailing Address
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Address Line | 350 BOULEVARD
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City | PASSAIC
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State | NJ
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Zip | 07055-2840
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Country | US
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Telephone | 973-365-3012
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OR PATIENT ACCOUNTS
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Name | ROBERT BODNAR
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Credential |
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Telephone | 973-365-3012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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