Healthcare Provider Details

I. General information

NPI: 1063657963
Provider Name (Legal Business Name): BETH ISRAEL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIRST AVENUE & 16TH STREET
NEW YORK NY
10003
US

IV. Provider business mailing address

160 WATER ST FL 24
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-3027
  • Fax: 212-256-3595
Mailing address:
  • Phone: 212-256-3296
  • Fax: 212-256-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number7002002H
License Number StateNY

VIII. Authorized Official

Name: MR. KENNETH BARRITT
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 646-605-4217