Healthcare Provider Details

I. General information

NPI: 1871756064
Provider Name (Legal Business Name): MOUNT SINAI MEDICAL CENTER UROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 540
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

4300 ALTON RD ASCHER BLDG 2ND FLOOR
MIAMI BEACH FL
33140-2800
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2499
  • Fax: 305-674-2899
Mailing address:
  • Phone: 305-695-1275
  • Fax: 305-535-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GINO SANTORINO
Title or Position: PRESIDENT CHIEF EXECUTIVE OFFICER
Credential:
Phone: 305-695-1275