Healthcare Provider Details

I. General information

NPI: 1528087541
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST BOX1240B- 6TH FLOOR
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

5 E 98TH ST BOX1240B- 6TH FLOOR
NEW YORK NY
10029-6501
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9469
  • Fax: 212-369-6389
Mailing address:
  • Phone: 212-241-9469
  • Fax: 212-369-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. FREDA BURSTYN
Title or Position: ADMINISTRATOR
Credential:
Phone: 212-659-9367