Basic Information
| Provider Information | |||||||||
| NPI: | 1013209535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY | ||||||||
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| OtherOrganizationName: | CORNELL MEDICAL ASSOCIATES AT 170 WILLIAMS ST. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 LEXINGTON AVE | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100226102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125905152 | ||||||||
| FaxNumber: | 2125905798 | ||||||||
| Practice Location | |||||||||
| Address1: | 170 WILLIAM ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100382612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125905741 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2011 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | KELLS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2125905741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.