Healthcare Provider Details

I. General information

NPI: 1962702340
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 PARK AVE
NEW YORK NY
10128-1003
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1621
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-0845
  • Fax:
Mailing address:
  • Phone: 212-731-7895
  • Fax: 212-348-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS A JABS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D., M.B.A.
Phone: 212-241-6752