Provider Demographics
NPI:1386711505
Name:AMSTERDAM MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:AMSTERDAM MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-841-3571
Mailing Address - Street 1:4988 STATE HIGHWAY 30
Mailing Address - Street 2:PO BOX 517
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7520
Mailing Address - Country:US
Mailing Address - Phone:518-842-3100
Mailing Address - Fax:518-841-3678
Practice Address - Street 1:4988 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7520
Practice Address - Country:US
Practice Address - Phone:518-842-3100
Practice Address - Fax:518-841-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2801000H261QP2300X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000400002001OtherBSNENY PROVIDER NUMBER
NY000902OtherEMPIRE BCBS PROVIDER NUM
NY00381420Medicaid
NY0129OtherMVP PROVIDER NUMBER
NY10005722OtherCDPHP PROVIDER NUMBER
NY000400002000OtherBSNENY PROVIDER NUMBER
NY000000005323OtherGHI PROVIDER NUMBER
NY6450165OtherAETNA PROVIDER NUMBER
NY000400002003OtherBSNENY PROVIDER NUMBER
NY0129OtherMVP PROVIDER NUMBER
NY6450165OtherAETNA PROVIDER NUMBER