# MARY IMMACULATE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316041924
- **Authorized official:** MARINA ADELMAN (BILLING DEPARTMENT)
- **Authorized official phone:** (718) 743-7090

## Contact information

- **Practice address:** 11449 SUTPHIN BLVD, JAMAICA, NY 11434-1022
- **Practice address phone:** (718) 558-6622
- **Mailing address:** 15211 89TH AVE, JAMAICA, NY 11432-3730
- **Mailing address phone:** (718) 743-7090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 026852 | NY | Yes |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 12/21/2007