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General NPI Number Information
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NPI Number | 1275976011
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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 | 04/11/2013
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 1468 MADISON AVE ANNENBERG BLD 2ND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10029-6508
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Country | US
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Telephone | 212-241-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E 42ND ST FL 10
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City | NEW YORK
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State | NY
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Zip | 10017-5626
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Country | US
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Telephone | 646-605-8119
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Fax |
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Authorized Official
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Title or Position | V.P.,CBO DIRECTOR FPA BILLING
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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