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General NPI Number Information
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NPI Number | 1093906828
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Entity Type | Organization
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Legal Business Name | BIMC FACULTY PRACTICE
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 10 UNION SQ E
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City | NEW YORK
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State | NY
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Zip | 10003-3314
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Country | US
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Telephone | 212-844-8690
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Fax |
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Provider Business Mailing Address
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Address Line | 160 WATER ST 20TH FL
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City | NEW YORK
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State | NY
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Zip | 10038-4922
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Country | US
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Telephone | 212-256-3539
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Fax |
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Authorized Official
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Title or Position | AVP
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Name | DEBORAH HACKETT
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Credential |
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Telephone | 212-256-3424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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