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General NPI Number Information
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NPI Number | 1215265517
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Entity Type | Organization
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Legal Business Name | COLUMBIA MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 71 PROSPECT AVENUE DENTAL PROGRAM
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City | HUDSON
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State | NY
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Zip | 12534
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Country | US
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Telephone | 518-669-7892
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Fax | 518-669-7893
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Provider Business Mailing Address
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Address Line | 71 PROSPECT AVE
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City | HUDSON
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State | NY
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Zip | 12534-2907
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Country | US
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Telephone | 518-669-7892
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Fax | 518-669-7893
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. VICENT J DINGMAN III
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Credential |
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Telephone | 518-828-8249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1001000H
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License Number State | NY
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