Basic Information
| Provider Information | |||||||||
| NPI: | 1174689665 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETH ISRAEL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WATER ST | ||||||||
| Address2: | 24TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100384922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122563296 | ||||||||
| FaxNumber: | 2122563594 | ||||||||
| Practice Location | |||||||||
| Address1: | FIRST AVENUE AND 16TH STREET | ||||||||
| Address2: | MILTON AND CARROLL PETRIE DIVISION | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124202000 | ||||||||
| FaxNumber: | 2122563594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | BRUNO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2125237140 | ||||||||
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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 | 273R00000X | 7002002H | NY | N | Hospital Units | Psychiatric Unit | 273Y00000X | 7002002H | NY | N | Hospital Units | Rehabilitation Unit | 276400000X | 7002002H | NY | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 282N00000X | 7001041H | NY | N | Hospitals | General Acute Care Hospital | 282N00000X | 7002002H | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00243105 | 05 | NY | MEDICAID | 000135 | 01 | NY | BLUE CROSS | OTHER | 000003 | 01 | NY | BLUE CROSS | OTHER | 00710430 | 05 | NY | MEDICAID | 01597108 | 05 | NY | MEDICAID | 02568243 | 05 | NY | MEDICAID |