Healthcare Provider Details

I. General information

NPI: 1285911800
Provider Name (Legal Business Name): BIMC FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W 60TH ST
NEW YORK NY
10023-7402
US

IV. Provider business mailing address

126 W 60TH ST
NEW YORK NY
10023-7402
US

V. Phone/Fax

Practice location:
  • Phone: 212-636-3970
  • Fax:
Mailing address:
  • Phone: 212-636-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH HACKETT
Title or Position: VP
Credential:
Phone: 212-256-3424