1811005754 NPI number — WEILL MEDICAL COLLEGE OF CORNELL

Table of content: (NPI 1811005754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811005754 NPI number — WEILL MEDICAL COLLEGE OF CORNELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEILL MEDICAL COLLEGE OF CORNELL
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:
6
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:
1811005754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 E 68TH ST
Provider Second Line Business Mailing Address:
BOX 585
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-746-3558
Provider Business Mailing Address Fax Number:
212-746-3988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-590-5151
Provider Business Practice Location Address Fax Number:
212-590-5798
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
PAIGE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT DIRECTOR
Authorized Official Telephone Number:
212-590-5151

Provider Taxonomy Codes

  • Taxonomy code: 2080P0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02691638 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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