Provider Demographics
NPI:1356516736
Name:BETH ISRAEL MEDICAL CENTER FACULTY PRACTICE
Entity type:Organization
Organization Name:BETH ISRAEL MEDICAL CENTER FACULTY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-879-4742
Mailing Address - Street 1:150 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5119
Mailing Address - Country:US
Mailing Address - Phone:212-879-4742
Mailing Address - Fax:212-288-2126
Practice Address - Street 1:150 E 71ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5119
Practice Address - Country:US
Practice Address - Phone:212-879-4742
Practice Address - Fax:212-288-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000500Medicare PIN