Healthcare Provider Details

I. General information

NPI: 1720055288
Provider Name (Legal Business Name): MANUELA ANITA ORJUELA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANUELA ANITA ORJUELA MD

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
NEW YORK NY
10032
US

IV. Provider business mailing address

100 LA SALLE ST
NEW YORK NY
10027-4703
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-7297
  • Fax:
Mailing address:
  • Phone: 212-662-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number189902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: