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General NPI Number Information
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NPI Number | 1528084910
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Entity Type | Organization
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Legal Business Name | CORNELL UNIVERSITY MEDICAL COLLEGE
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 21 BLOOMINGDALE RD
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1504
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Country | US
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Telephone | 914-997-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BLOOMINGDALE RD
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1504
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE AIDE II
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Name | ASTARA N CREWS
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Credential |
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Telephone | 914-997-5791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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