Basic Information
| Provider Information | |||||||||
| NPI: | 1447521836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY | ||||||||
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| OtherOrganizationName: | CARDIOLOGY OUTREACH NJ | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 LEXINGTON AVE. | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | NEW YORK CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100226102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125905741 | ||||||||
| FaxNumber: | 2125905798 | ||||||||
| Practice Location | |||||||||
| Address1: | 82 EAST ALLENDALE ROAD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | SADDLE RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074583057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012361183 | ||||||||
| FaxNumber: | 2012361460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2012 | ||||||||
| LastUpdateDate: | 01/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | KELLS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIOPHER | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR POBO | ||||||||
| AuthorizedOfficialTelephone: | 2125905741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.