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General NPI Number Information
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NPI Number | 1164623278
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Entity Type | Organization
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Legal Business Name | NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 775 PARK AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-3976
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Country | US
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Telephone | 631-659-4400
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Fax | 631-659-4578
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Provider Business Mailing Address
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Address Line | 775 PARK AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-3976
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Country | US
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Telephone | 631-659-4400
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Fax | 631-659-4578
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JANET STREET
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Credential |
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Telephone | 631-351-3703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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