Basic Information
| Provider Information | |||||||||
| NPI: | 1760155204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK UNIVERSITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117143927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167588600 | ||||||||
| FaxNumber: | 9294559773 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117143927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167588600 | ||||||||
| FaxNumber: | 9294559773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2021 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | RUBIN | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP CLINICAL AFFAIRS, AMB CARE | ||||||||
| AuthorizedOfficialTelephone: | 2122632672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.