Provider Demographics
NPI:1730297011
Name:TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Entity Type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Other - Org Name:KREITCMAN PET CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRTUDES
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-305-1948
Mailing Address - Street 1:630 W 168TH ST # 28
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-1948
Mailing Address - Fax:212-305-5777
Practice Address - Street 1:722 WEST 168TH STREET R1 FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3733
Practice Address - Country:US
Practice Address - Phone:212-342-2899
Practice Address - Fax:212-342-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty