Healthcare Provider Details

I. General information

NPI: 1598901191
Provider Name (Legal Business Name): MOUNT SINAI INTENSIVISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON ROAD
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

PO BOX 19186
MIAMI FL
33101-9186
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2121
  • Fax: 305-525-7919
Mailing address:
  • Phone: 305-674-2222
  • Fax: 305-674-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE CHUTKAN
Title or Position: SENIOR VP FINANCE
Credential:
Phone: 305-674-2662