=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710303128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEILL CORNELL MEDICAL COLLEGE-DIV OF HEMATOLOGY & ONCOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2014
-----------------------------------------------------
Last Update Date | 03/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 YORK AVE 12TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-962-2275
-----------------------------------------------------
Fax | 646-962-1607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 YORK AVE 12TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-962-2275
-----------------------------------------------------
Fax | 646-962-1607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIVISION ADMINISTRATOR
-----------------------------------------------------
Name | PAULA GOLDSTEIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-962-2275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | 135654-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------