Healthcare Provider Details

I. General information

NPI: 1679814974
Provider Name (Legal Business Name): ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MADISON AVE 1ST FLOOR
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-241-8717
  • Fax: 212-876-7805
Mailing address:
  • Phone: 646-605-8119
  • Fax: 646-605-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL MACNEILL
Title or Position: VICE PRESIDENT, CBO DIRECTOR
Credential:
Phone: 646-605-8112