Healthcare Provider Details

I. General information

NPI: 1730297011
Provider Name (Legal Business Name): TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 WEST 168TH STREET R1 FL
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

630 W 168TH ST # 28
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-2899
  • Fax: 212-342-3745
Mailing address:
  • Phone: 212-305-1948
  • Fax: 212-305-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. VIRTUDES REYES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 212-305-1948