Healthcare Provider Details

I. General information

NPI: 1407807753
Provider Name (Legal Business Name): NEW YORK UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE SK 10W
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

530 1ST AVE SK 10W
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7391
  • Fax:
Mailing address:
  • Phone: 212-263-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW T RUBIN
Title or Position: SR. ASST. DEAN FOR CLINICAL AFFAIRS
Credential:
Phone: 212-263-2824