Provider Demographics
NPI:1346566262
Name:NEW YORK PREBYSTERIAN MEDICAL CENTER
Entity Type:Organization
Organization Name:NEW YORK PREBYSTERIAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEYANIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA-MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:212-942-0414
Mailing Address - Street 1:45 FAIRVIEW AVE APT 7H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2755
Mailing Address - Country:US
Mailing Address - Phone:212-932-5355
Mailing Address - Fax:212-932-5161
Practice Address - Street 1:45 FAIRVIEW AVE APT 7H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2755
Practice Address - Country:US
Practice Address - Phone:212-932-5355
Practice Address - Fax:212-932-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066512-1261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility