Healthcare Provider Details

I. General information

NPI: 1740224914
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MADISON AVE ATRAN 610
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1428 MADISON AVE ATRAN 610
NEW YORK NY
10029-6508
US

V. Phone/Fax

Practice location:
  • Phone: 212-731-7772
  • Fax: 212-534-7491
Mailing address:
  • Phone: 212-731-7772
  • Fax: 212-534-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberCLIA 33D1051889
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLIA 33D1051889
License Number StateNY

VIII. Authorized Official

Name: DOUGLAS A JABS
Title or Position: CHIEF EXECUTIVE OFFICIER
Credential: M.D., MBA
Phone: 212-241-6228