Healthcare Provider Details

I. General information

NPI: 1508584830
Provider Name (Legal Business Name): NEW YORK UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 QUANTUM BLVD
BOYNTON BEACH FL
33426-8668
US

IV. Provider business mailing address

186 JORALEMON ST
BROOKLYN NY
11201-4356
US

V. Phone/Fax

Practice location:
  • Phone: 877-648-2964
  • Fax:
Mailing address:
  • Phone: 929-455-2392
  • Fax: 929-455-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW RUBIN
Title or Position: SR. VP CLINICAL AFFAIRS, AMB CARE
Credential:
Phone: 212-263-2672