Provider Demographics
NPI:1164688826
Name:NEW YORK PRESBYTERIAN HOSPITAL
Entity Type:Organization
Organization Name:NEW YORK PRESBYTERIAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEBBS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:347-840-0351
Mailing Address - Street 1:3959 BROADWAY # BHN-616
Mailing Address - Street 2:DEPARTMENT OF PEDIATRIC PSYCHIATRY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:347-840-0351
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY # BHN-616
Practice Address - Street 2:DEPARTMENT OF PEDIATRIC PSYCHIATRY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:347-840-0351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 072479282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren