Provider Demographics
NPI:1922406628
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:COLUMBIA ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND SENIOR VICE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-605-5526
Mailing Address - Street 1:622 W 168TH ST
Mailing Address - Street 2:PH-11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-5974
Mailing Address - Fax:212-305-6193
Practice Address - Street 1:5141 BROADWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-305-5974
Practice Address - Fax:212-305-6193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW11611Medicare PIN