Healthcare Provider Details

I. General information

NPI: 1912964768
Provider Name (Legal Business Name): MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD 5 WARNER
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

4300 ALTON RD 5 WARNER
MIAMI BEACH FL
33140-2800
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2662
  • Fax: 305-674-2007
Mailing address:
  • Phone: 305-674-2662
  • Fax: 305-674-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800017502
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number4066
License Number StateFL

VIII. Authorized Official

Name: MR. WAYNE CHUTKAN
Title or Position: VICE PRESIDENT OF FINANCE
Credential: CPA
Phone: 305-674-2662