Provider Demographics
NPI:1285601237
Name:HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS
Entity type:Organization
Organization Name:HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:FHFMA
Authorized Official - Phone:914-493-7909
Mailing Address - Street 1:105 MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5829
Mailing Address - Country:US
Mailing Address - Phone:845-943-6007
Mailing Address - Fax:845-943-6038
Practice Address - Street 1:105 MARYS AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5848
Practice Address - Country:US
Practice Address - Phone:845-943-6007
Practice Address - Fax:845-943-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3185OtherGHI PROVIDER ID
NY6450795OtherAETNA PROV ID
NY000702OtherBLUE CROSS PROVIDER NUMBE
NY00274020Medicaid
NY103185OtherWELLCARE PROV ID
NY143278OtherVALUE OPTIONS PROV ID
NY10005742OtherCDPHP PROVIDER ID
NYUV5282OtherMVP HEALTH PLAN PROV ID
NY000702OtherBLUE CROSS PROVIDER NUMBE