MEDICARE: HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3185	OTHER	NY	GHI PROVIDER ID
2	6450795	OTHER	NY	AETNA PROV ID
3	000702	OTHER	NY	BLUE CROSS PROVIDER NUMBE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	103185	OTHER	NY	WELLCARE PROV ID
6	143278	OTHER	NY	VALUE OPTIONS PROV ID
7	10005742	OTHER	NY	CDPHP PROVIDER ID
8	UV5282	OTHER	NY	MVP HEALTH PLAN PROV ID

General Provider Information

NPI Number	:	1285601237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS

Provider Business Mailing Address
First Line	:	105 MARYS AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-5829
Country	:	US
Telephone Number	:	845-943-6007
Fax Number	:	845-943-6038

Provider Business Practice Location Address
First Line	:	105 MARYS AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-5848
Country	:	US
Telephone Number	:	845-943-6007
Fax Number	:	845-943-6038

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MARIO DIFIGLIA
Credential	:	FHFMA
Telephone Number	:	914-493-7909

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/27/2025

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Directions to “HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS ” Practice Location

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