| Organization Name: | EDWARD JOHN NOBLE HOSPITAL OF GOUVERNEUR NY |
| NPI Number: | 1316940745 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICIA ROGERS (PATIENT ACCOUNTING SUPERVISOR) |
| Mailing Address: | 77 W Barney St Gouverneur |
| State: | NY US |
| Postal Code: | 136421040 |
| Phone Number: | 3155359244 |
| Fax Number: | 3155359305 |
| NPI Enumeration Date: | 05/31/2005 |
| NPI Last Update Date: | 08/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | 013468 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Clinic Pharmacy |
| Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |