Basic Information
| Provider Information | |||||||||
| NPI: | 1720007883 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYH-CUMC OPHTHALMOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 EAST 68TH STREET | ||||||||
| Address2: | ST/826 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100214870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127462868 | ||||||||
| FaxNumber: | 2127468125 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 EAST 68TH STREET | ||||||||
| Address2: | ST/826 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100214870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127462868 | ||||||||
| FaxNumber: | 2127468125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PELTON | ||||||||
| AuthorizedOfficialFirstName: | SHAUN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2127462868 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.