Healthcare Provider Details

I. General information

NPI: 1720636483
Provider Name (Legal Business Name): MOUNT SINAI SCHOOL OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MERRICK RD
OCEANSIDE NY
11572-1431
US

IV. Provider business mailing address

185 MERRICK RD
OCEANSIDE NY
11572-1431
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-6550
  • Fax:
Mailing address:
  • Phone: 516-766-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ALICIA GRESHAM
Title or Position: VP NETWORK OPERATIONS
Credential:
Phone: 212-659-9038