=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558440123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUSTEES OF COLUMBIA UNIVERSITY ADULT EKG GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 03/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 622 WEST 168TH STREET
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032-3702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-7634
-----------------------------------------------------
Fax | 212-305-3137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ADULT EKG GROUP CARDIOLOGY DIVISION GPO BOX 27050
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10087-7050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-305-7634
-----------------------------------------------------
Fax | 212-305-3137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN DIVISION OF CARDIOLOGY
-----------------------------------------------------
Name | DR. ALLAN SCHWARTZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-305-7634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------