=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659513521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. MARY'S HOSPITAL AT AMSTERDAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2009
-----------------------------------------------------
Last Update Date | 03/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 427 GUY PARK AVE
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-841-7434
-----------------------------------------------------
Fax | 518-841-7433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 427 GUY PARK AVE
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-841-7434
-----------------------------------------------------
Fax | 518-841-7433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | VICTOR GIULIANELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-841-7101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------