1013043421 NPI number — DR. BRIAN KEITH CLINTON M.D., PH.D.

Table of content: DR. BRIAN KEITH CLINTON M.D., PH.D. (NPI 1013043421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013043421 NPI number — DR. BRIAN KEITH CLINTON M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLINTON
Provider First Name:
BRIAN
Provider Middle Name:
KEITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

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:
1013043421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177 FORT WASHINGTON AVE
Provider Second Line Business Mailing Address:
MILSTEIN 9 GARDEN NORTH; ATTN: BRIAN CLINTON
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-706-7369
Provider Business Mailing Address Fax Number:
646-706-7369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 W 168TH ST FL 12
Provider Second Line Business Practice Location Address:
COLUMBIA PSYCHIATRY SPECIALTY CLINICS
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-706-7369
Provider Business Practice Location Address Fax Number:
646-706-7369
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  256811 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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