Organization
TRUSTEES OF COLUMBIA UNIVERSITY
Active
Other names
Harlem Faculty Practice - Oral
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUDHA PENTYALA (DIRECTOR)
(718) 579-6021
Entity
Organization
Contact information
Practice address
506 LENOX AVE, WP BUILDING, 7TH FLOOR, ROOM 742, NEW YORK, NY 10037-1802
(212) 939-3501
Mailing address
506 LENOX AVENUE, WP BUILDING, 7TH FLOOR, ROOM 742, NEW YORK, NY 10037-1889
(212) 939-3501
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02866071
—
NY
Enumeration date
04/20/2009
Last updated
04/20/2009
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