Basic Information
| Provider Information | |||||||||
| NPI: | 1578899878 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYU LANGONE MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3312 HUDSON AVE APT 9L | ||||||||
| Address2: | |||||||||
| City: | UNION CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070875969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5514824353 | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 1ST AVE | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122637300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 10/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | TOOMEY | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 12122636912 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 207RI0011X | 05 | NY | MEDICAID |