Provider Demographics
NPI:1245220722
Name:NYU UROGYNECOLOGY PROGRAM
Entity Type:Organization
Organization Name:NYU UROGYNECOLOGY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. ASST. DEAN OF CLINICAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-263-2824
Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:HCC 5TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-8888
Mailing Address - Fax:
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:HCC 5TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01720754Medicaid
NY01720754Medicaid