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Organization
BIMC FACULTY PRACTICE
Active
Organization
BIMC FACULTY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH HACKETT (AVP)
(212) 256-3424
Entity
Organization
Contact information
Practice address
10 UNION SQ E, SUITE 5B, NEW YORK, NY 10003-3314
(212) 844-8767
Mailing address
10 UNION SQ E, SUITE 5B, NEW YORK, NY 10003-3314
(212) 844-8767
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
207Y00000X
Otolaryngology Physician
—
NULL
207Y00000X
Otolaryngology Physician
—
—
Other
Enumeration date
08/20/2007
Last updated
02/02/2012
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