MEDICARE: BIMC FACULTY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1538323910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIMC FACULTY PRACTICE

Provider Business Mailing Address
First Line	:	160 WATER ST
Second Line	:	20TH FL
City	:	NEW YORK
State	:	NY
Zip	:	10038-4922
Country	:	US
Telephone Number	:	212-256-3539
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 NATHAN D PERLMAN PL
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10003-3801
Country	:	US
Telephone Number	:	212-420-4714
Fax Number	:

Authorized Official
Title or Position	:	AVP
Name	:	DEBORAH HACKETT
Credential	:
Telephone Number	:	212-256-3424

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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Directions to “BIMC FACULTY PRACTICE ” Practice Location

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