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General NPI Number Information
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NPI Number | 1154696615
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Entity Type | Organization
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Legal Business Name | FACULTY PRACTICE ASSOCIATES MOUNT SINAI SCHOOL OF MEDICINE
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 638 COLUMBUS AVE
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City | NEW YORK
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State | NY
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Zip | 10024-1406
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Country | US
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Telephone | 212-731-7895
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GUSTAVE L LEVY PL # 1621
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City | NEW YORK
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State | NY
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Zip | 10029-6500
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Country | US
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Telephone | 212-731-7895
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Fax | 212-731-6788
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Authorized Official
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Title or Position | VICE PRESIDENT, CBO DIRECTOR
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Name | CRYSTAL MACNEILL
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Credential |
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Telephone | 212-731-6802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | NY
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