Healthcare Provider Details

I. General information

NPI: 1073584926
Provider Name (Legal Business Name): CORNELL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HO PLAZA
ITHACA NY
14853
US

IV. Provider business mailing address

110 HO PLAZA
ITHACA NY
14853
US

V. Phone/Fax

Practice location:
  • Phone: 607-255-5155
  • Fax: 607-255-0269
Mailing address:
  • Phone: 607-255-5155
  • Fax: 607-255-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JADA HAMILTON
Title or Position: DIRECTOR
Credential: MD
Phone: 607-255-7492