Provider Demographics
NPI:1346256674
Name:BETH ISRAEL MEDICAL CENTER
Entity Type:Organization
Organization Name:BETH ISRAEL MEDICAL CENTER
Other - Org Name:BETH ISRAEL DIAGNOSTIC PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MAC
Authorized Official - Last Name:WENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-420-2124
Mailing Address - Street 1:1900 HEMPSTEAD TPKE C/O CANDICE BRENNAN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1724
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:770-666-9097
Practice Address - Street 1:10 NATHAN D PERLMAN PLACE C/O BEVERLY COOPER
Practice Address - Street 2:SUITE 12S34 - PATHOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3851
Practice Address - Country:US
Practice Address - Phone:212-420-2124
Practice Address - Fax:212-420-3449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETH ISRAEL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001630Medicare PIN