Healthcare Provider Details

I. General information

NPI: 1114297389
Provider Name (Legal Business Name): NEW YORK UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE. SUITE 120
LAKE SUCCESS NY
11042
US

IV. Provider business mailing address

1999 MARCUS AVE. SUITE 120
LAKE SUCCESS NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-6611
  • Fax: 516-466-6080
Mailing address:
  • Phone: 516-466-6611
  • Fax: 516-466-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: ANDREW T. RUBIN
Title or Position: SR. ASST. DEAN OF CLINICAL AFFAIRS
Credential:
Phone: 646-501-3224