Healthcare Provider Details

I. General information

NPI: 1962422949
Provider Name (Legal Business Name): DEPARTMENT OF PSYCHIATRY AT MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1230
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1230
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8806
  • Fax:
Mailing address:
  • Phone: 212-659-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. ELSIE DENNIS
Title or Position: BILLING MANAGER
Credential:
Phone: 212-659-8806