Basic Information
| Provider Information | |||||||||
| NPI: | 1245355270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEILL MEDICAL COLLEGE OF CORNELL | ||||||||
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| OtherOrganizationName: | CORNELL UNIVERSITY MEDICAL COLLEGE ECG | ||||||||
| 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: | 2125905151 | ||||||||
| FaxNumber: | 2125905798 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 E 70TH ST | ||||||||
| Address2: | STARR 409 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100219800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127462150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | BUTLER | ||||||||
| AuthorizedOfficialFirstName: | PAIGE | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2125905151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00791199 | 05 | NY | MEDICAID |