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Organization

BIMC FACULTY PRACTICE

Active
Other names
COMMUNITY PRIMARY CARE
Organization subpart
No

Provider details

NPI number
Authorized official
DEBORAH HACKETT (VP)
(212) 256-3424
Entity
Organization

Contact information

Practice address
1825 PARK AVE, NEW YORK, NY 10035-1641
(212) 774-3254
Mailing address
160 WATER ST, 20TH FL, NEW YORK, NY 10038-4922
(212) 774-3254

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
2084P0802X
Addiction Psychiatry Physician

Other

Enumeration date
04/06/2011
Last updated
04/06/2011
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