=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295030781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MOUNT SINAI HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2011
-----------------------------------------------------
Last Update Date | 01/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 MADISON AVE L4-46
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10029-6514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-765-8021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 436 E 69TH ST APT 2J
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-765-8021
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PSYCHIATRIC NURSING
-----------------------------------------------------
Name | DR. PATRICIA MATOS
-----------------------------------------------------
Credential | MSN, PHD
-----------------------------------------------------
Telephone | 212-241-8780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 401352
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------