Provider Demographics
NPI:1982993184
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:COLUMBIADOCTORS AMBULATORY CARE NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:MJ
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-342-2939
Mailing Address - Street 1:615 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 KELBY ST
Practice Address - Street 2:8TH FLOOR CLINICAL REVENUE OFFICE
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2943
Practice Address - Country:US
Practice Address - Phone:212-304-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03845145Medicaid
NYA100048149Medicare PIN