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General NPI Number Information
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NPI Number | 1669805065
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Entity Type | Organization
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Legal Business Name | METROPOLITAN
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1901 1ST AVE PEDIATRICS ROOM 523
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City | NEW YORK
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State | NY
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Zip | 10029-7404
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Country | US
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Telephone | 212-423-7834
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 3RD AVENUE APT B2C
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City | NEW YORK
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State | NY
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Zip | 10029-6291
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Country | US
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Telephone | 646-633-8925
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | ANDRE BROUSSARD
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Credential |
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Telephone | 212-423-7834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number |
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License Number State |
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