Provider Demographics
NPI:1366467243
Name:TRUSTEES OF COLUMBIA UNIVERSITY DEPT OF OBSTETRICS AND GYN ULTRASOUND
Entity Type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY DEPT OF OBSTETRICS AND GYN ULTRASOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPT CHAIRMAN OF OBSTETRICS AND GYN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:D'ALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-305-2377
Mailing Address - Street 1:622 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-7334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEK011Medicare ID - Type Unspecified