Organization
HEALTHALLIANCE MARYS AVENUE CAMPUS
Active
Other names
Benedictine Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN SCHUPP (DIRECTOR, PATIENT ACCOUNTS)
(845) 943-6007
Entity
Organization
Contact information
Practice address
105 MARY'S AVE, KINGSTON, NY 12401
(845) 943-6007
(845) 943-6038
Mailing address
105 MARY'S AVE, KINGSTON, NY 12401
(845) 943-6007
(845) 943-6038
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000302
BLUE CROSS PROVIDER NUMBE
NY
05
—
00274020
—
NY
01
—
10005742
CDPHP PROVIDER ID
NY
01
—
103185
WELLCARE PROVIDER ID
NY
01
—
3185
GHI PROVIDER ID
NY
01
—
6450795
AETNA PROVIDER ID
NY
01
—
UV5282
MVP PROVIDER ID
NY
Enumeration date
03/08/2006
Last updated
03/23/2015
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