Healthcare Provider Details

I. General information

NPI: 1710261656
Provider Name (Legal Business Name): TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK CARDIOLOGY ASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 700
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE SUITE 700
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-593-7800
  • Fax: 914-593-7857
Mailing address:
  • Phone: 914-593-7800
  • Fax: 914-593-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK MCDOUGLE
Title or Position: SVP/ CHIEF OPERATING OFFICER
Credential:
Phone: 212-305-6607