1043328354 NPI number — TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK

Table of content: LISA MARIE MCCLOY CRNA (NPI 1982613014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043328354 NPI number — TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043328354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 WEST 168TH ST
Provider Second Line Business Mailing Address:
#28
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-305-1948
Provider Business Mailing Address Fax Number:
212-305-5777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 WEST 51ST STREET STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10019-1951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-326-8518
Provider Business Practice Location Address Fax Number:
212-326-8528
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYES
Authorized Official First Name:
VIRTUDES
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
212-305-6912

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02186198 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: S7X081 . This is a "EMPIRE BCBS #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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