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General NPI Number Information
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NPI Number | 1609072602
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Entity Type | Organization
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Legal Business Name | CORNELL UNIV MED COLLEGE
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 56 W 45TH ST 9TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10036-4206
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Country | US
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Telephone | 212-764-5178
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Fax | 212-764-5644
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Provider Business Mailing Address
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Address Line | 56 W 45TH ST 9TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10036-4206
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Country | US
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Telephone | 212-764-5178
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Fax | 212-764-5644
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | CHRISTOPHER KELLS
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Credential |
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Telephone | 212-590-5741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 070611059
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License Number State | NY
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