Healthcare Provider Details

I. General information

NPI: 1497374805
Provider Name (Legal Business Name): MOUNT SINAI COMMUNITY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 W OGDEN AVE
CHICAGO IL
60608-1647
US

IV. Provider business mailing address

26467 NETWORK PL
CHICAGO IL
60673-1264
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6840
  • Fax: 773-732-2529
Mailing address:
  • Phone: 773-257-2500
  • Fax: 773-257-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH CAPUTO
Title or Position: MANAGER
Credential:
Phone: 773-257-2905