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General NPI Number Information
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NPI Number | 1215064993
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Entity Type | Organization
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Legal Business Name | NYU MEDICAL CENTER
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 462 1ST AVE
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City | NEW YORK
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State | NY
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Zip | 10016-9196
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Country | US
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Telephone | 121-256-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 880 E 34TH ST
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City | BROOKLYN
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State | NY
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Zip | 11210-2731
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Country | US
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Telephone | 718-434-2502
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. ORLAND KENTON BOUCHER
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Credential | P.A.
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Telephone | 12122637300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 010398-1
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License Number State | NY
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