Healthcare Provider Details

I. General information

NPI: 1205882586
Provider Name (Legal Business Name): WEILL MEDICAL COLLEGE OF CORNELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10021-4870
US

IV. Provider business mailing address

575 LEXINGTON AVE SUITE 500
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-0780
  • Fax: 212-746-4883
Mailing address:
  • Phone: 212-590-5741
  • Fax: 212-590-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER T. KELLS
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 212-590-5741