Provider Demographics
NPI:1811005754
Name:WEILL MEDICAL COLLEGE OF CORNELL
Entity Type:Organization
Organization Name:WEILL MEDICAL COLLEGE OF CORNELL
Other - Org Name:CORNELL PEDIATRIC INTENSIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-590-5151
Mailing Address - Street 1:525 E 68TH ST
Mailing Address - Street 2:BOX 585
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-3558
Mailing Address - Fax:212-746-3988
Practice Address - Street 1:575 LEXINGTON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6102
Practice Address - Country:US
Practice Address - Phone:212-590-5151
Practice Address - Fax:212-590-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691638Medicaid
NYWCW101Medicare PIN