Provider Demographics
NPI:1114038353
Name:NEW YORK UNIVERSITY MEDICAL CENTER FACULTY PRACTICE RADIOLOGY
Entity Type:Organization
Organization Name:NEW YORK UNIVERSITY MEDICAL CENTER FACULTY PRACTICE RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:OKHIRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-263-0001
Mailing Address - Street 1:650 1ST AVE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3240
Mailing Address - Country:US
Mailing Address - Phone:212-263-0050
Mailing Address - Fax:
Practice Address - Street 1:650 1ST AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3240
Practice Address - Country:US
Practice Address - Phone:212-263-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106485OtherVYTRA
NY0M0320OtherHEALTH NET
NY106482OtherVYTRA
NY4103054OtherGHI
NYANC1501OtherOXFORD
NYCD7508OtherRR MEDICARE
NY106489OtherVYTRA
NY48938OtherAETNA
NY106479OtherVYTRA
NY4103054OtherGHI
NY=========GROUPOther1199