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General NPI Number Information
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NPI Number | 1669854824
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Entity Type | Organization
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Legal Business Name | NORTH SHORE MEDICAL GROUP OF THE MOUNT SINAI SCHOOL OF MEDICINE
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 1436 BROADWAY
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City | HEWLETT
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State | NY
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Zip | 11557-1405
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Country | US
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Telephone | 929-210-6570
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Fax | 929-210-6571
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Provider Business Mailing Address
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Address Line | 1436 BROADWAY
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City | HEWLETT
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State | NY
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Zip | 11557-1405
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Country | US
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Telephone | 929-210-6570
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Fax | 929-210-6571
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Authorized Official
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Title or Position | VP NETWORK OPERATIONS
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Name | MS. ALICIA GRESHAM
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Credential |
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Telephone | 212-659-9038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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