Provider Demographics
NPI:1669770756
Name:TRUSTEES OF COLUMBIA UNIVERSITY COLUMBIADOCTORS OF THE HUDSON VALLEY
Entity type:Organization
Organization Name:TRUSTEES OF COLUMBIA UNIVERSITY COLUMBIADOCTORS OF THE HUDSON VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP/CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDOUGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-305-6607
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-342-5155
Mailing Address - Fax:
Practice Address - Street 1:222 ROUTE 59 STE 302
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5208
Practice Address - Country:US
Practice Address - Phone:845-368-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty