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General NPI Number Information
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NPI Number | 1194168377
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 04/08/2013
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Provider Practice Location Address
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Address Line | 1611 S CICERO AVE
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City | CICERO
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State | IL
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Zip | 60804-1520
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Country | US
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Telephone | 708-477-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 3537 PAYSPHERE CIR
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City | CHICAGO
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State | IL
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Zip | 60674-0035
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Country | US
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Telephone | 708-786-2099
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Fax | 708-786-2992
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Authorized Official
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Title or Position | CMO
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Name | JOHN E VAZQUEZ
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Credential | MD
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Telephone | 773-257-3850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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