Provider Demographics
NPI:1053466425
Name:ST. PETER'S HOSPITAL OF THE CITY OF ALBANY
Entity type:Organization
Organization Name:ST. PETER'S HOSPITAL OF THE CITY OF ALBANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-5634
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-275-4090
Mailing Address - Fax:518-275-4004
Practice Address - Street 1:1 PINE WEST PLAZA
Practice Address - Street 2:WASHINGTON AVE EXT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5537
Practice Address - Country:US
Practice Address - Phone:518-464-9999
Practice Address - Fax:518-464-9650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETER'S HOSPITAL OF THE CITY OF ALBANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY892050OtherMVP PROVIDER NUMBER
NY10087013OtherCDPH PROVIDER NUMBER
NY000400597002OtherBLUE SHIELD PROVIDER NUMB
NY=========OtherUHC PROVIDER NUMBER