Healthcare Provider Details

I. General information

NPI: 1669870390
Provider Name (Legal Business Name): THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY 8TH FLOOR
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

622 W 168TH ST PH-11
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5974
  • Fax: 212-305-6193
Mailing address:
  • Phone: 212-305-5974
  • Fax: 212-305-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK MCDOUGLE
Title or Position: CHIEF OPERATING OFFICER
Credential: MPH
Phone: 212-305-6607