Healthcare Provider Details

I. General information

NPI: 1245220722
Provider Name (Legal Business Name): NYU UROGYNECOLOGY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE HCC 5TH FL
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

530 1ST AVE HCC 5TH FL
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8888
  • Fax:
Mailing address:
  • Phone: 212-263-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic 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: 212-263-2824