Healthcare Provider Details

I. General information

NPI: 1679397491
Provider Name (Legal Business Name): NEW YORK UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MAMARONECK AVE STE 200
HARRISON NY
10528-2430
US

IV. Provider business mailing address

450 MAMARONECK AVE STE 200
HARRISON NY
10528-2430
US

V. Phone/Fax

Practice location:
  • Phone: 914-556-4960
  • Fax: 914-265-9164
Mailing address:
  • Phone: 914-556-4960
  • Fax: 914-265-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
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