1871692210 NPI number — WEILL MEDICAL COLLEGE OF CORNELL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871692210 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:
1871692210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 EAST 68TH SREET
Provider Second Line Business Mailing Address:
BOX 171 RM F-1228 DEPT. OF PYSCHIATRY
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10065-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-746-0235
Provider Business Mailing Address Fax Number:
212-746-3687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 EAST 68TH SREET
Provider Second Line Business Practice Location Address:
BOX 171 RM F-1228 DEPT. OF PYSCHIATRY
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10065-4870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-746-0235
Provider Business Practice Location Address Fax Number:
212-746-3687
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EGELBAUM
Authorized Official First Name:
ZEMFIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT SUPERVISOR
Authorized Official Telephone Number:
212-746-0235

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02204644 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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