Basic Information
| Provider Information | |||||||||
| NPI: | 1376576892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | ||||||||
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| OtherOrganizationName: | COLUMBIA OPHTHALMOLOGY CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 W 165TH ST | ||||||||
| Address2: | FLANZER SUITE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059535 | ||||||||
| FaxNumber: | 2123425293 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 W 165TH ST | ||||||||
| Address2: | FLANZER SUITE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059535 | ||||||||
| FaxNumber: | 2123425293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 10/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DEAN | ||||||||
| AuthorizedOfficialTelephone: | 2123425225 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.