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General NPI Number Information
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NPI Number | 1255882734
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Entity Type | Organization
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Legal Business Name | ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 129 SLOSSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-2522
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Country | US
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Telephone | 718-720-5928
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Fax | 718-720-6706
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Provider Business Mailing Address
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Address Line | 129 SLOSSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-2522
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Country | US
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Telephone | 718-720-5928
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Fax | 718-720-6706
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Authorized Official
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Title or Position | VP OF NETWORK OPERATIONS
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Name | ALICIA GRESHAM
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Credential |
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Telephone | 212-659-9038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 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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