Provider Demographics
NPI:1497098685
Name:WEILL CORNELL MEDICAL COLLEGE
Entity Type:Organization
Organization Name:WEILL CORNELL MEDICAL COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:201-281-0894
Mailing Address - Street 1:445 E 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5664
Mailing Address - Country:US
Mailing Address - Phone:212-746-9422
Mailing Address - Fax:
Practice Address - Street 1:445 E 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5664
Practice Address - Country:US
Practice Address - Phone:212-746-9422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306436261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology