Provider Demographics
NPI:1710491568
Name:WEILL MEDICAL COLLEGE OF CORNELL
Entity Type:Organization
Organization Name:WEILL MEDICAL COLLEGE OF CORNELL
Other - Org Name:CORNELL EMER. DEPT TOX. PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:ENROLLMENT & CREDENTIALING COORD.
Authorized Official - Prefix:
Authorized Official - First Name:FABIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-962-2543
Mailing Address - Street 1:575 LEXINGTON AVE RM 540
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6145
Mailing Address - Country:US
Mailing Address - Phone:646-962-2543
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Single Specialty