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General NPI Number Information
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NPI Number | 1134492549
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI HOSPITAL OF QUEENS
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 2510 30TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-2448
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Country | US
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Telephone | 718-932-7151
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 30TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-2448
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, MEDICAL STAFF SERVICES
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Name | GARY MCCOLLIN
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Credential |
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Telephone | 718-932-7151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 015446
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License Number State | NY
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