Provider Demographics
NPI:1417071945
Name:WEILL MEDICAL COLLEGE OF CORNELL
Entity Type:Organization
Organization Name:WEILL MEDICAL COLLEGE OF CORNELL
Other - Org Name:CORNELL ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-590-5741
Mailing Address - Street 1:575 LEXINGTON AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:212-590-5152
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BAKER BUILDING 20TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-1503
Practice Address - Fax:212-746-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856179Medicaid
NYW09621Medicare PIN