Provider Demographics
NPI:1821238668
Name:NEW YORK UNIVERSITY COLLEGE OF DENTISTRY & NURSING
Entity Type:Organization
Organization Name:NEW YORK UNIVERSITY COLLEGE OF DENTISTRY & NURSING
Other - Org Name:NYU COLLEGE OF NURSING
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC. ASSOC. DEAN FOR ADMIN FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MPA
Authorized Official - Phone:212-998-9930
Mailing Address - Street 1:345 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4020
Mailing Address - Country:US
Mailing Address - Phone:212-998-9879
Mailing Address - Fax:212-995-4083
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-998-9879
Practice Address - Fax:212-995-4083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK UNIVERSITY COLLEGE OF DENTISTRY & NURSING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182007163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01334674Medicaid