Provider Demographics
NPI:1942363098
Name:BETH ISRAEL AMBULATORY CARE SERVICES CORP
Entity Type:Organization
Organization Name:BETH ISRAEL AMBULATORY CARE SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-636-8468
Mailing Address - Street 1:160 WATER ST
Mailing Address - Street 2:24TH FLOOR ATTN: JILLIAN SUMPTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4922
Mailing Address - Country:US
Mailing Address - Phone:212-256-3296
Mailing Address - Fax:212-256-3595
Practice Address - Street 1:3121 KINGS HIGHWAY
Practice Address - Street 2:BETH ISRAEL AMBULATORY CARE SERVICES CORP
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:212-256-3296
Practice Address - Fax:212-256-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001269P261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003611OtherBLUE CROSS
NY01660526Medicaid
NYZ95151Medicare PIN