Healthcare Provider Details

I. General information

NPI: 1114358348
Provider Name (Legal Business Name): ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-241-6980
  • Fax: 212-534-6091
Mailing address:
  • Phone: 212-241-6980
  • Fax: 212-534-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARTA MOSCICKA-TECZA
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 212-241-9203