Basic Information
| Provider Information | |||||||||
| NPI: | 1558942060 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYU HOSPITALS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 WALL ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100052178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465013224 | ||||||||
| FaxNumber: | 2122634539 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 OLD COUNTRY RD STE 460 | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115014293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632752 | ||||||||
| FaxNumber: | 5166639373 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2021 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | AMBROSECCHIA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6465019352 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 1223S0112X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223G0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.