Healthcare Provider Details

I. General information

NPI: 1932120656
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MADISON AVE.
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

PO BOX 13213
NEWARK NJ
07101-3213
US

V. Phone/Fax

Practice location:
  • Phone: 212-987-3100
  • Fax: 212-731-5220
Mailing address:
  • Phone: 212-731-7696
  • Fax: 212-348-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

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