Basic Information
| Provider Information | |||||||||
| NPI: | 1649489717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW PRESBYTERIAN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 W 71ST ST APT 1C | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100233887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128773522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 622 W 168TH ST # VC2-205 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123056262 | ||||||||
| FaxNumber: | 2123056279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JACOBS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | ORTHOPEDIC PODIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 2123056262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP1100X | N002541 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Podiatric |
ID Information
| ID | Type | State | Issuer | Description | 00414333 | 05 | NY | MEDICAID |