Provider Demographics
NPI:1922044304
Name:NEW YORK UNIVERSITY
Entity type:Organization
Organization Name:NEW YORK UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-443-1055
Mailing Address - Street 1:726 BROADWAY
Mailing Address - Street 2:4TH FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-9502
Mailing Address - Country:US
Mailing Address - Phone:212-443-1050
Mailing Address - Fax:212-443-1051
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:4TH FLR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9502
Practice Address - Country:US
Practice Address - Phone:212-443-1050
Practice Address - Fax:212-443-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336I0012X, 333600000X
NY0234243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2059688OtherPK