Healthcare Provider Details

I. General information

NPI: 1679881577
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE OF NEW YORK UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 86TH ST RM 502
NEW YORK NY
10028-7725
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 212-744-2345
  • Fax: 212-744-2129
Mailing address:
  • Phone: 212-731-7895
  • Fax: 212-348-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology 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: 21224136752