Basic Information
| Provider Information | |||||||||
| NPI: | 1326287566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE NEW YORK AND PRESBYTERIAN HOSPITAL | ||||||||
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| OtherOrganizationName: | THE PRESBYTERIAN HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 W 57TH ST. | ||||||||
| Address2: | SUITE 1200; ATTENTION: JUANA ROMERO | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100192925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126327556 | ||||||||
| FaxNumber: | 2126327591 | ||||||||
| Practice Location | |||||||||
| Address1: | 622 W 168TH STREET, 4TH FLOOR | ||||||||
| Address2: | END STAGE RENAL DISEASE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053394 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | LANTOS | ||||||||
| AuthorizedOfficialFirstName: | PHYLLIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP CFO-TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 2123056845 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 00243178 | 05 | NY | MEDICAID |