Healthcare Provider Details

I. General information

NPI: 1245377712
Provider Name (Legal Business Name): WEILL MEDICAL COLEGE OF CORNELL UNIVERSITY DEPT. OF PSTCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E 61 STREET 1352
NEW YORK NY
10021-8722
US

IV. Provider business mailing address

425 E 61ST ST 1352
NEW YORK NY
10021-8722
US

V. Phone/Fax

Practice location:
  • Phone: 212-821-0789
  • Fax:
Mailing address:
  • Phone: 212-821-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number154202
License Number StateNY

VIII. Authorized Official

Name: DR. PHILIP J. WILNER
Title or Position: VICE CHAIRMAN
Credential: M.D.
Phone: 212-746-3705