Healthcare Provider Details

I. General information

NPI: 1992356521
Provider Name (Legal Business Name): TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

400 KELBY ST 8TH FLOOR, CLINICAL REVENUE OFFICE
FORT LEE NJ
07024
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-6470
  • Fax:
Mailing address:
  • Phone: 212-304-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SM0001X
TaxonomyMolecular Genetic Pathology (Medical Genetics) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES MICHAEL MCKIERNAN
Title or Position: CEO AND SENIOR VICE DEAN
Credential: MD
Phone: 212-305-5526