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General NPI Number Information
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NPI Number | 1841652914
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Entity Type | Organization
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Legal Business Name | WEILL CORNELL
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 1300 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-4805
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Country | US
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Telephone | 845-926-4968
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Fax |
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Provider Business Mailing Address
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Address Line | 174 BAY 29TH ST
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City | BROOKLYN
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State | NY
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Zip | 11214-5020
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Country | US
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Telephone | 917-696-1497
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Fax |
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Authorized Official
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Title or Position | RESIDENT GPY-1
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Name | MISS YANA KAPUSTINA
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Credential | DDS
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Telephone | 917-696-1497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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