Provider Demographics
NPI:1538352026
Name:WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
Entity type:Organization
Organization Name:WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ZEMFIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-746-0235
Mailing Address - Street 1:21 BLOOMINGDALE RD
Mailing Address - Street 2:DEPT. OF PSYCHIATRY
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1504
Mailing Address - Country:US
Mailing Address - Phone:914-997-5791
Mailing Address - Fax:
Practice Address - Street 1:21 BLOOMINGDALE RD
Practice Address - Street 2:DEPT. OF PSYCHIATRY
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1504
Practice Address - Country:US
Practice Address - Phone:914-997-5791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02204644Medicaid
NY02204644Medicaid