Healthcare Provider Details

I. General information

NPI: 1437172335
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE ANESTHESIOLOGY
ASTORIA NY
11102-2448
US

IV. Provider business mailing address

PO BOX 12023
NEWARK NJ
07101-5023
US

V. Phone/Fax

Practice location:
  • Phone: 800-627-4470
  • Fax: 412-937-5710
Mailing address:
  • Phone: 800-627-4470
  • Fax: 412-937-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS A JABS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D., M.B.A.
Phone: 212-241-6752