Healthcare Provider Details

I. General information

NPI: 1275594434
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 MADISON AVE
NEW YORK NY
10029-6542
US

IV. Provider business mailing address

ONE GUSTAVE L LEVY PLACE BOX 1070
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-658-8552
  • Fax:
Mailing address:
  • Phone: 212-241-5561
  • Fax: 212-860-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICIA A BLOOM
Title or Position: ASSOCIATE CLINICAL PROFESSOR GUIATI
Credential: MD
Phone: 212-241-5561