Healthcare Provider Details

I. General information

NPI: 1003863168
Provider Name (Legal Business Name): COLUMBIA PRESBYTERIAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST ROOM PH1271
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

10 BONNIE LN
NEW CITY NY
10956-3324
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4920
  • Fax:
Mailing address:
  • Phone: 845-634-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number429058
License Number StateNY

VIII. Authorized Official

Name: DR. DONNA MANCINI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 212-305-4629