Provider Demographics
NPI:1497907539
Name:TRUSTEES OF COLUMBIA UNIVERSITY - SCM
Entity Type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY - SCM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMOOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-666-6312
Mailing Address - Street 1:127 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3723
Mailing Address - Country:US
Mailing Address - Phone:212-666-6312
Mailing Address - Fax:212-662-2980
Practice Address - Street 1:127 W 127TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3723
Practice Address - Country:US
Practice Address - Phone:212-666-6312
Practice Address - Fax:212-662-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01572403251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01572403Medicaid