Basic Information
| Provider Information | |||||||||
| NPI: | 1710022306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BETH ISRAEL MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | BETH ISRAEL NEONATAL ASSOCIATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WATER ST | ||||||||
| Address2: | 20TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100384922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122533539 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 NATHAN D PERLMAN PL | ||||||||
| Address2: | 16TH ST AT 1ST AVE | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124202000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 03/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | HACKETT | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 2122563424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.