Basic Information
Provider Information | |||||||||
NPI: | 1083633036 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE NEW YORK AND PRESBYTERIAN HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NEW YORK-PRESBYTERIAN HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 525 EAST 68TH STREET | ||||||||
Address2: | BOX 150 | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 10065 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2122974430 | ||||||||
FaxNumber: | 2122974275 | ||||||||
Practice Location | |||||||||
Address1: | 525 E 68TH ST | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100214870 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2127465454 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2006 | ||||||||
LastUpdateDate: | 03/14/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LANTOS | ||||||||
AuthorizedOfficialFirstName: | PHYLLIS | ||||||||
AuthorizedOfficialMiddleName: | R.F. | ||||||||
AuthorizedOfficialTitleorPosition: | EVP, CFO, TREASURER | ||||||||
AuthorizedOfficialTelephone: | 2123056845 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
ID | Type | State | Issuer | Description | 000528 | 01 | NY | EBCBS | OTHER | 00243518 | 05 | NY |   | MEDICAID |