Healthcare Provider Details

I. General information

NPI: 1124392212
Provider Name (Legal Business Name): ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST SECOND FLOOR
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

P.O. BOX 28082
NEW YORK NY
10087-8082
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8470
  • Fax: 212-241-3023
Mailing address:
  • Phone: 212-987-3100
  • Fax: 646-605-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL MACNEILL
Title or Position: CBO, VICE PRESIDENT
Credential:
Phone: 646-605-8112