Basic Information
| Provider Information | |||||||||
| NPI: | 1700107281 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW YORK UNIVERSITY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NYU GREAT NECK MEDICAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 488 GREAT NECK RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110214315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164826747 | ||||||||
| FaxNumber: | 5164824851 | ||||||||
| Practice Location | |||||||||
| Address1: | 488 GREAT NECK RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110214315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164826747 | ||||||||
| FaxNumber: | 5164824851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2010 | ||||||||
| LastUpdateDate: | 06/18/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RUBIN | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | SR ASS DEAN FOR CLINICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 2122632824 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW YORK UNIVERSITY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.