Provider Demographics
NPI:1366803215
Name:NEW YORK UNIVERSITY
Entity type:Organization
Organization Name:NEW YORK UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:WIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:212-998-9667
Mailing Address - Street 1:345 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4020
Mailing Address - Country:US
Mailing Address - Phone:212-998-9667
Mailing Address - Fax:212-995-4920
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-998-9667
Practice Address - Fax:212-995-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery