Provider Demographics
NPI:1316493992
Name:ST JOSEPHS HOSPITAL
Entity type:Organization
Organization Name:ST JOSEPHS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-409-3791
Mailing Address - Street 1:2 APPLE TREE LANE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090
Mailing Address - Country:US
Mailing Address - Phone:315-409-3791
Mailing Address - Fax:
Practice Address - Street 1:2 APPLE TREE LN
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2302
Practice Address - Country:US
Practice Address - Phone:315-409-3791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPHS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402032-1283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital