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General NPI Number Information
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NPI Number | 1629410592
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Entity Type | Organization
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Legal Business Name | MOUNT SINAI
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Dates
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Enumeration Date | 07/21/2013
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Last Update Date | 07/21/2013
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Provider Practice Location Address
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Address Line | 1468 MADISON AVE BOX 1116
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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 | 631-824-8100
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Fax | 212-996-2230
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Provider Business Mailing Address
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Address Line | 59 E MAIN ST SUITE 13
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City | BAY SHORE
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State | NY
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Zip | 11706-8332
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Country | US
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Telephone | 212-824-8100
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Fax | 212-996-2230
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Authorized Official
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Title or Position | PHYSICIAN ASSOCIATE
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Name | MR. DUSTIN LEE BAKER
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Credential | PA-C
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Telephone | 212-824-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 16550
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License Number State | NY
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