Healthcare Provider Details

I. General information

NPI: 1811005754
Provider Name (Legal Business Name): WEILL MEDICAL COLLEGE OF CORNELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 LEXINGTON AVE SUITE 500
NEW YORK NY
10022-6102
US

IV. Provider business mailing address

525 E 68TH ST BOX 585
NEW YORK NY
10021-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-590-5151
  • Fax: 212-590-5798
Mailing address:
  • Phone: 212-746-3558
  • Fax: 212-746-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAIGE BUTLER
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 212-590-5151