Basic Information
Provider Information
NPI: 1518241918
EntityType: 2
ReplacementNPI:  
OrganizationName: WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: WESTCHESTER MEDICAL CENTER
OtherOrganizationType: 3
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 575 LEXINGTON AVE
Address2: SUITE 540
City: NEW YORK
State: NY
PostalCode: 100226102
CountryCode: US
TelephoneNumber: 2125905152
FaxNumber: 2125905798
Practice Location
Address1: 100 WOODS RD
Address2:  
City: VALHALLA
State: NY
PostalCode: 105951530
CountryCode: US
TelephoneNumber: 9144937000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/04/2011
LastUpdateDate: 10/04/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KELLS
AuthorizedOfficialFirstName: CHRISTOPHER
AuthorizedOfficialMiddleName: T
AuthorizedOfficialTitleorPosition: ASSOICATE DIRECTOR
AuthorizedOfficialTelephone: 2125905741
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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