Healthcare Provider Details

I. General information

NPI: 1225045958
Provider Name (Legal Business Name): STEPHANIE H FACTOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVENUE ANNENBERG B-1 MT SINAI HOSP JACK MARTIN FUND CLINIC
NEW YORK NY
10029
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PLACE BOX 3000 MOUNT SINAI DEPARTMENT OF MEDICINE
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6150
  • Fax:
Mailing address:
  • Phone: 212-987-3100
  • Fax: 212-731-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number201250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: