Provider Demographics
NPI:1871713438
Name:NEW YORK UNIVERSITY
Entity type:Organization
Organization Name:NEW YORK UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOC DEAN CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:122-443-1322
Mailing Address - Street 1:222 E 41ST ST FL 22
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6739
Mailing Address - Country:US
Mailing Address - Phone:212-263-7552
Mailing Address - Fax:212-263-6931
Practice Address - Street 1:222 E 41ST ST FL 22
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6739
Practice Address - Country:US
Practice Address - Phone:212-263-7552
Practice Address - Fax:212-263-6931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-26
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
NY021314-2261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No122300000XDental ProvidersDentistGroup - Multi-Specialty