Healthcare Provider Details

I. General information

NPI: 1336683622
Provider Name (Legal Business Name): THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E FORDHAM RD
BRONX NY
10458-5149
US

IV. Provider business mailing address

622 W 168TH ST PH-11-1130
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5974
  • Fax: 212-305-6193
Mailing address:
  • Phone: 212-305-5974
  • Fax: 212-305-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM LEVINE
Title or Position: CHAIR/CHIEF OF SERVICE
Credential: M.D.
Phone: 212-305-5974