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General NPI Number Information
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NPI Number | 1538301528
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI OF QUEENS
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 695 EAST 68TH ST HN307
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-772-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 30TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11102-2448
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Country | US
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Telephone | 718-932-1000
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. THERESA ANNE DAVIS
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Credential | RN, MS, ANPC
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Telephone | 718-965-4101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | F304063
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License Number State | NY
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