Organization
NEWARK WAYNE COMMUNITY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS CRILLY (CFO/EXEC. VP)
(585) 922-5497
Entity
Organization
Contact information
Practice address
1200 DRIVING PARK AVE, POB 111 DRIVING PARK AVE, NEWARK, NY 14513-1057
(315) 332-2022
Mailing address
1200 DRIVING PARK AVE, P.O. BOX 111 DRIVING PARK AVE, NEWARK, NY 14513-1057
(315) 332-2022
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
5820000H
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012002611
BLUE CHOICE INPATIENT
NY
01
—
014002611
BLUE CHOICE OUTPATIENT
NY
05
—
03001654
—
NY
01
—
CA3158
RAILROAD MEDICARE
NY
01
—
ESHO1301
PREFERRED CARE INPATIENT
NY
01
—
HO1300
PREFERRED CARE
NY
Enumeration date
10/11/2006
Last updated
01/24/2020
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