Healthcare Provider Details

I. General information

NPI: 1154657641
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL # 1230
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL # 1230
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8806
  • Fax:
Mailing address:
  • Phone: 212-659-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS JABS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD, MBA
Phone: 212-241-4739