Healthcare Provider Details

I. General information

NPI: 1508795089
Provider Name (Legal Business Name): ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W 57TH ST FL 6
NEW YORK NY
10019-2923
US

IV. Provider business mailing address

150 E 42ND ST FL 5
NEW YORK NY
10017-5612
US

V. Phone/Fax

Practice location:
  • Phone: 646-493-1588
  • Fax:
Mailing address:
  • Phone: 646-605-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN GILELS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 646-605-8119