Healthcare Provider Details

I. General information

NPI: 1093009755
Provider Name (Legal Business Name): NYULMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2011
Last Update Date: 05/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

11 EVELYN LN
SYOSSET NY
11791-5806
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7000
  • Fax:
Mailing address:
  • Phone: 516-921-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number304020
License Number StateNY

VIII. Authorized Official

Name: MRS. LISA BETH DUBROW
Title or Position: NP
Credential: NP
Phone: 212-263-5590