Provider Demographics
NPI:1578596243
Name:TRUSTEES OF COLUMBIA UNIVERSITY IN CITY OF NY HEMATOLOGY ONCOLOGY
Entity Type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY IN CITY OF NY HEMATOLOGY ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT FOR HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-305-9331
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:12TH FLOOR, SUITE 208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01820584Medicaid
NYW1L881Medicare ID - Type Unspecified