1689239105 NPI number — NYMC- SCHOOL OF MEDICINE FACULTY PRACTICE CORPORATION

Table of content: (NPI 1689239105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689239105 NPI number — NYMC- SCHOOL OF MEDICINE FACULTY PRACTICE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYMC- SCHOOL OF MEDICINE FACULTY PRACTICE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689239105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SUNSHINE COTTAGE RD
Provider Second Line Business Mailing Address:
DEPARTMENT OF FAMILY & COMMUNITY MEDICINE
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-594-2260
Provider Business Mailing Address Fax Number:
914-594-2261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 SKYLINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10532-2134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-828-0435
Provider Business Practice Location Address Fax Number:
914-594-2261
Provider Enumeration Date:
05/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HALPERIN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CHANCELLOR/CEO
Authorized Official Telephone Number:
914-594-4900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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