Provider Demographics
NPI:1255535993
Name:WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
Entity type:Organization
Organization Name:WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-590-5741
Mailing Address - Street 1:575 LEXINGTON AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:212-590-5741
Mailing Address - Fax:212-590-5798
Practice Address - Street 1:1305 YORK AVE.
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-590-5741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-14
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW09571Medicare ID - Type UnspecifiedMEDICARE GRP. NUMBER
NYWWT521Medicare PIN