Basic Information
| Provider Information | |||||||||
| NPI: | 1871504217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | ||||||||
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| OtherOrganizationName: | DEPARTMENT OF SURGERY VALLEY NPPS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 AUDUBON AVE | ||||||||
| Address2: | 3RD FLOOR #209 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100324220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123056788 | ||||||||
| FaxNumber: | 2123059474 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 N VAN DIEN AVE | ||||||||
| Address2: | |||||||||
| City: | RIDGEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074502726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2014478377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 09/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2123052752 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.