Basic Information
| Provider Information | |||||||||
| NPI: | 1669805065 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METROPOLITAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1810 3RD AVENUE | ||||||||
| Address2: | APT B2C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466338925 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 1ST AVE | ||||||||
| Address2: | PEDIATRICS ROOM 523 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124237834 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2013 | ||||||||
| LastUpdateDate: | 08/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | BROUSSARD | ||||||||
| AuthorizedOfficialFirstName: | ANDRE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2124237834 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.