Healthcare Provider Details

I. General information

NPI: 1902965858
Provider Name (Legal Business Name): THE MOUNT SINAI REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 95TH ST APT 30B
NEW YORK NY
10128-4075
US

IV. Provider business mailing address

1450 MADISON AVE # 1674
NEW YORK NY
10029-6508
US

V. Phone/Fax

Practice location:
  • Phone: 518-225-1501
  • Fax:
Mailing address:
  • Phone: 212-241-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. MARISSA ROSE CAPULLO
Title or Position: RECREATION THERAPIST
Credential: B.S.
Phone: 212-241-9188