Basic Information
| Provider Information | |||||||||
| NPI: | 1669578324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYU LANGONE HOSPITALS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 WALL ST FL 10 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100052103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002376977 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 E 17TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122631481 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 8002376977 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NYU LANGONE HOSPITALS | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 7002053H | NY | N | Hospital Units | Rehabilitation Unit | 282N00000X | 7002053H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00243389 | 05 | NY | MEDICAID | 000290 | 01 | NY | BLUE CROSS | OTHER |