Healthcare Provider Details

I. General information

NPI: 1104295716
Provider Name (Legal Business Name): ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE EAST
NEW YORK NY
10003
US

IV. Provider business mailing address

150 EAST 42ND STREET 10TH FLOOR
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8200
  • Fax:
Mailing address:
  • Phone: 646-605-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL MACNEILL
Title or Position: VICE PRESIDENT, CBO DIRECTOR
Credential:
Phone: 646-605-8112