Basic Information
| Provider Information | |||||||||
| NPI: | 1619911526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUSTEES OF COLUMBIA UNIVERSITY IN DEPARTMENT OF PSYCHIATRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 W 168TH ST | ||||||||
| Address2: | NEUROLOGICAL INSTITUTE 12-1222 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123052330 | ||||||||
| FaxNumber: | 2123059657 | ||||||||
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| Address1: | 622 W 168TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123052330 | ||||||||
| FaxNumber: | 2123059657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | SCRIVENER | ||||||||
| AuthorizedOfficialFirstName: | IAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2123046308 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 02378169 | 05 | NY | MEDICAID |