Healthcare Provider Details

I. General information

NPI: 1922411065
Provider Name (Legal Business Name): ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE SUITE 10C
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

150 EAST 42ND STREET 10TH FL.
NEW YORK NY
10017-5626
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-3452
  • Fax: 212-523-8066
Mailing address:
  • Phone: 646-605-8119
  • 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: MS. CRYSTAL MACNEILL
Title or Position: VP, CBO DIRECTOR
Credential:
Phone: 646-605-8112