Provider Demographics
NPI:1477745743
Name:TRIBECA INTERNAL MEDICINE & INFECTIOUS DISEASES
Entity Type:Organization
Organization Name:TRIBECA INTERNAL MEDICINE & INFECTIOUS DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-374-2145
Mailing Address - Street 1:122 FULTON ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2765
Mailing Address - Country:US
Mailing Address - Phone:212-374-2145
Mailing Address - Fax:212-374-2159
Practice Address - Street 1:122 FULTON ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2765
Practice Address - Country:US
Practice Address - Phone:212-374-2145
Practice Address - Fax:212-374-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179207207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY179207OtherLICENSE