MEDICARE: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician
3	207UN0901X	Nuclear Cardiology Physician
4	163WI0500X	Infusion Therapy Registered Nurse
5	207RG0100X	Gastroenterology Physician
6	2085R0202X	Diagnostic Radiology Physician
7	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
8	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1457867707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI

Provider Business Mailing Address
First Line	:	150 E 42ND ST FL 5
Second Line	:	5.A.30.6
City	:	NEW YORK
State	:	NY
Zip	:	10017-5612
Country	:	US
Telephone Number	:	646-634-9814
Fax Number	:

Provider Business Practice Location Address
First Line	:	476 KLONDIKE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6216
Country	:	US
Telephone Number	:	718-761-1156
Fax Number	:	718-761-1047

Authorized Official
Title or Position	:	AVP OPERATIONS
Name	:	JANET STREET
Credential	:
Telephone Number	:	646-354-3680

Provider Enumeration Date	:	12/22/2017
Last Update Date	:	02/26/2026

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Directions to “ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI ” Practice Location

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