Provider Demographics
NPI:1619911526
Name:TRUSTEES OF COLUMBIA UNIVERSITY IN DEPARTMENT OF PSYCHIATRY
Entity Type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY IN DEPARTMENT OF PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-304-6308
Mailing Address - Street 1:710 W 168TH ST
Mailing Address - Street 2:NEUROLOGICAL INSTITUTE 12-1222
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3726
Mailing Address - Country:US
Mailing Address - Phone:212-305-2330
Mailing Address - Fax:212-305-9657
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-2330
Practice Address - Fax:212-305-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02378169Medicaid
NYWVB151Medicare PIN