Healthcare Provider Details

I. General information

NPI: 1326311614
Provider Name (Legal Business Name): MOUNT SINAI DEPARTMENT OF ORTHOPAEDIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W GRAND AVE SUITE 500
MONTVALE NJ
07645-1813
US

IV. Provider business mailing address

5 E 98TH ST BOX 1188
NEW YORK NY
10029-6501
US

V. Phone/Fax

Practice location:
  • Phone: 201-391-8282
  • Fax:
Mailing address:
  • Phone: 212-241-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number238595
License Number StateNY

VIII. Authorized Official

Name: JANINE LOTA
Title or Position: ADMINISTRATIVE COORDINATOR
Credential:
Phone: 212-241-1643