=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154601854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NY ROGER A MAXFIELD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2011
-----------------------------------------------------
Last Update Date | 09/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 E 60TH ST STE 320
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-326-8415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 E 60TH ST STE 320
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-326-8415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SNR VP & CFO
-----------------------------------------------------
Name | JOANNE M.J QUAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-342-2939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 141229
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------