Provider Demographics
NPI:1871692210
Name:WEILL MEDICAL COLLEGE OF CORNELL
Entity type:Organization
Organization Name:WEILL MEDICAL COLLEGE OF CORNELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ZEMFIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-746-0235
Mailing Address - Street 1:525 EAST 68TH SREET
Mailing Address - Street 2:BOX 171 RM F-1228 DEPT. OF PYSCHIATRY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-4870
Mailing Address - Country:US
Mailing Address - Phone:212-746-0235
Mailing Address - Fax:212-746-3687
Practice Address - Street 1:525 EAST 68TH SREET
Practice Address - Street 2:BOX 171 RM F-1228 DEPT. OF PYSCHIATRY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-0235
Practice Address - Fax:212-746-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02204644Medicaid
NY02204644Medicaid