Healthcare Provider Details

I. General information

NPI: 1679611628
Provider Name (Legal Business Name): MOUNT SINAI COMMUNITY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 W 15TH
CHICAGO IL
60608-1647
US

IV. Provider business mailing address

3537 PAYSPHERE CIR
CHICAGO IL
60674-0035
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6840
  • Fax:
Mailing address:
  • Phone: 708-786-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN E VAZQUEZ
Title or Position: CHIEF MEDICAL OFFICER
Credential: M.D.
Phone: 773-257-6850