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General NPI Number Information
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NPI Number | 1013331818
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI COMMUNITY FOUNDATION
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 1501 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1732
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Country | US
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Telephone | 773-257-6663
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Fax | 773-257-6431
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Provider Business Mailing Address
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Address Line | 1501 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60608-1732
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Country | US
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Telephone | 773-257-6663
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Fax | 773-257-6431
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Authorized Official
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Title or Position | CMO
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Name | JOHN VAZQUEZ
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Credential |
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Telephone | 773-257-6850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | NUMBER
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License Number State | IL
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