Basic Information
| Provider Information | |||||||||
| NPI: | 1790732352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRUSTEES OF COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | ||||||||
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| OtherOrganizationName: | DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 W. 165TH STREET, BOX 92 | ||||||||
| Address2: | DEPARTMENT OF OPHTHALMOLOGY | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059734 | ||||||||
| FaxNumber: | 2123425450 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 W. 165TH STREET | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059535 | ||||||||
| FaxNumber: | 2123425450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 08/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | FIGUEROA | ||||||||
| AuthorizedOfficialFirstName: | BEATRICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2123056096 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 02365346 | 05 | NY | MEDICAID |