Provider Demographics
NPI:1164555124
Name:NEW YORK UNIVERSITY
Entity Type:Organization
Organization Name:NEW YORK UNIVERSITY
Other - Org Name:NEW YORK UNIVERSITY COLLEGE OF DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. ASSOC. DEAN FOR ADMIN FINANCE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MPA
Authorized Official - Phone:212-998-9930
Mailing Address - Street 1:345 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4020
Mailing Address - Country:US
Mailing Address - Phone:212-998-9879
Mailing Address - Fax:212-995-4851
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-998-9879
Practice Address - Fax:212-995-4851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021314-2261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01334674Medicaid