Healthcare Provider Details

I. General information

NPI: 1871718288
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAST 98TH. STREET 12TH. FLOOR
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

PO BOX 13337
NEWARK NJ
07101-3337
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8035
  • Fax: 212-659-8066
Mailing address:
  • Phone: 212-241-3856
  • Fax: 212-348-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS A. JABS
Title or Position: CEO-FACULTY PRACTICE ASSOCIATES
Credential: M.D., M.B.A.
Phone: 212-241-6752