Provider Demographics
NPI:1902989221
Name:NEWARK WAYNE COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:NEWARK WAYNE COMMUNITY HOSPITAL
Other - Org Name:NEWARK WAYNE COMM HOSP - PSYCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-922-1223
Mailing Address - Street 1:1200 DRIVING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-332-2022
Mailing Address - Fax:
Practice Address - Street 1:1200 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-332-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5820000H273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0120026XYOtherBLUECHOICE INPATIENT PSY
NYHO130POtherPREFERREDCARE PSYCH
NY000900002001OtherHEALTHNOW PSYCH
NY00354458Medicaid
NY97OtherBLUESHIELD OUTPT PSYCH
NYXYOtherBLUESHIELD INPATIENT PSY
NYXYOtherBLUESHIELD INPATIENT PSY
NY97OtherBLUESHIELD OUTPT PSYCH
NYHO130POtherPREFERREDCARE PSYCH