MEDICARE: ST. MARYS CENTER INC

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	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972599322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARYS CENTER INC

Provider Business Mailing Address
First Line	:	512-16 WEST 126TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027
Country	:	US
Telephone Number	:	212-665-5992
Fax Number	:	212-665-1855

Provider Business Practice Location Address
First Line	:	512-516 WEST 126TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027
Country	:	US
Telephone Number	:	212-665-5992
Fax Number	:	212-665-1855

Authorized Official
Title or Position	:	MANAGER
Name	:	USHA TAITT
Credential	:
Telephone Number	:	212-665-5992

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	09/12/2007

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