Provider Demographics
NPI:1720196090
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 PRESBYTERIAN NEURO-INTERVENTIONAL RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRTUDES
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING COORDI
Authorized Official - Phone:212-305-6912
Mailing Address - Street 1:630 WEST 168TH STREET MC28
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-1948
Mailing Address - Fax:212-305-5777
Practice Address - Street 1:622 WEST 168TH STREET, MHB-8 SO. KNUCKLE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-6384
Practice Address - Fax:212-305-5476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085N0700X
NYNXA2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW35001Medicare PIN