Provider Demographics
NPI:1902099351
Name:BIMC FACULTY PRACTICE
Entity Type:Organization
Organization Name:BIMC FACULTY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-256-3424
Mailing Address - Street 1:10 UNION SQ E
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3314
Mailing Address - Country:US
Mailing Address - Phone:212-844-8767
Mailing Address - Fax:
Practice Address - Street 1:10 UNION SQ E
Practice Address - Street 2:SUITE 5B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3314
Practice Address - Country:US
Practice Address - Phone:212-844-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZZVZ1Medicare PIN