1245377712 NPI number — WEILL MEDICAL COLEGE OF CORNELL UNIVERSITY DEPT. OF PSTCHIATRY

Table of content: (NPI 1245377712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245377712 NPI number — WEILL MEDICAL COLEGE OF CORNELL UNIVERSITY DEPT. OF PSTCHIATRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEILL MEDICAL COLEGE OF CORNELL UNIVERSITY DEPT. OF PSTCHIATRY
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:
1245377712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 E 61ST ST
Provider Second Line Business Mailing Address:
1352
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-8722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-821-0789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 E 61 STREET
Provider Second Line Business Practice Location Address:
1352
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-8722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-821-0789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILNER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VICE CHAIRMAN
Authorized Official Telephone Number:
212-746-3705

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  154202 , 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)





Copyright © 2007-2025 www.npivalidator.com