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General NPI Number Information
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NPI Number | 1447008446
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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 | 05/07/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL # 4500
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City | NEW YORK
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State | NY
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Zip | 10029-6504
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Country | US
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Telephone | 407-667-0444
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Fax |
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Provider Business Mailing Address
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Address Line | 851 TRAFALGAR CT STE 200E
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City | MAITLAND
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State | FL
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Zip | 32751-7420
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NATIONAL CREDENTIALING DIRECTOR
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Name | TIFFANY ANN JOLLEY
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Credential |
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Telephone | 713-458-4169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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