Healthcare Provider Details

I. General information

NPI: 1447225016
Provider Name (Legal Business Name): DR. HETTY CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY COLUMBIA .EDU
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

466 W 141ST ST
NEW YORK NY
10031-6202
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7250
  • Fax: 212-544-1974
Mailing address:
  • Phone: 212-281-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: