Provider Demographics
NPI:1891712972
Name:TRUSTEES OF COLUMBIA UNIVERSITY
Entity Type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY
Other - Org Name:HARLEM FACULTY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGADEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-939-2740
Mailing Address - Street 1:506 MALCOLM X BLVD
Mailing Address - Street 2:WP 522
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-1802
Mailing Address - Country:US
Mailing Address - Phone:212-939-2740
Mailing Address - Fax:212-939-2759
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:WP 522
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-2740
Practice Address - Fax:212-939-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEP931Medicare ID - Type Unspecified