Provider Demographics
NPI:1245377712
Name:WEILL MEDICAL COLEGE OF CORNELL UNIVERSITY DEPT. OF PSTCHIATRY
Entity type:Organization
Organization Name:WEILL MEDICAL COLEGE OF CORNELL UNIVERSITY DEPT. OF PSTCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-746-3705
Mailing Address - Street 1:425 E 61ST ST
Mailing Address - Street 2:1352
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8722
Mailing Address - Country:US
Mailing Address - Phone:212-821-0789
Mailing Address - Fax:
Practice Address - Street 1:425 E 61 STREET
Practice Address - Street 2:1352
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8722
Practice Address - Country:US
Practice Address - Phone:212-821-0789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154202261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63537Medicare UPIN