Provider Demographics
NPI:1992931232
Name:ST. MARY'S HOSPITAL
Entity type:Organization
Organization Name:ST. MARY'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:EUNICE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:TEACHER
Authorized Official - Phone:718-968-2269
Mailing Address - Street 1:9226 AVENUE J
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11236
Mailing Address - Country:US
Mailing Address - Phone:718-968-2269
Mailing Address - Fax:718-968-2269
Practice Address - Street 1:9226 AVENUE J
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3935
Practice Address - Country:US
Practice Address - Phone:718-968-2269
Practice Address - Fax:718-968-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY379624681252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY931178500OtherGHI