Basic Information
Provider Information
NPI: 1508175324
EntityType: 2
ReplacementNPI:  
OrganizationName: WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
LastName:  
FirstName:  
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Credential:  
OtherOrganizationName: WCMC BMT
OtherOrganizationType: 3
OtherLastName:  
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Mailing Information
Address1: 575 LEXINGTON AVE
Address2: SUITE 540
City: NEW YORK
State: NY
PostalCode: 100226102
CountryCode: US
TelephoneNumber: 6469622010
FaxNumber: 2127463305
Practice Location
Address1: 520 E 70TH ST
Address2: STARR 341
City: NEW YORK
State: NY
PostalCode: 100219800
CountryCode: US
TelephoneNumber: 6469622010
FaxNumber: 2127463305
Other Information
ProviderEnumerationDate: 09/28/2010
LastUpdateDate: 09/28/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: KELLS
AuthorizedOfficialFirstName: CHRISTOPHERT
AuthorizedOfficialMiddleName: T.
AuthorizedOfficialTitleorPosition: ASSOCIATE DIRECTOR
AuthorizedOfficialTelephone: 2125905741
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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